Microvascular Decompression for Trigeminal Neuralgia Due to Venous Neurovascular Conflict: A Case Report Featuring a 2D Operative Video.

Trigeminal neuralgia (TN) has a prevalence ranging from 0.03% to 0.3%, with an annual incidence of approximately 4.7 cases per 100,000 individuals. Among these, around 11.4% are attributed to pure venous neurovascular conflict. The transverse pontine vein emerged as the predominant offending vein. There is no consensus on the best surgical technique for these cases. However, three principal surgical techniques have been described: coagulation and cut-off, interposition, and transposition. In this report featuring an operative video, we present the case of A 37-year-old woman with shock-like and burning pain in the V2 and V3 territory on the right side for four months, associated with lacrimation and triggered by brushing her teeth or drinking cold drinks. Her pain was refractory to oxcarbazepine (2400 mg/day). Her MRI showed a neurovascular conflict on the right. She subsequently underwent microvascular decompression (MVD) surgery. During the surgery, we found a purely venous conflict. We proceeded with Teflon interposition. The patient had an uneventful recovery, with complete initial pain relief and, at three months, a favorable early outcome (Barrow Neurological Institute (BNI) pain intensity score IIIb), with pain adequately controlled on a low dose of oxcarbazepine (300 mg/day). The patient consented to the procedure and to the publication of this report. Institutional ethics committee approval was not required because of the retrospective and fully anonymized nature of the case report.