Effectiveness of Differentiated Treatment Strategies and Quality-of-Life Assessment in Patients with Trigeminal Neuralgia

Abstract

Background and objective. Trigeminal neuralgia (TN) is a severe paroxysmal facial pain disorder for which treatment must be individualized. This study aimed to improve treatment outcomes in patients with TN through a differentiated approach that accounts for disease severity, somatic status and quality of life (QoL).

Methods. A 【retrospective / prospective — specify】 observational study of 171 patients with TN treated in the inpatient neurosurgery department of the multidisciplinary clinic of the Tashkent Medical Academy (2019–2023). Patients were allocated to three groups by treatment modality, disease severity and somatic status: conservative treatment plus peripheral trigeminal branch blocks (Group 1, n = 55); Gasserian ganglion blocks plus trigeminal branch exeresis (Group 2, n = 57); and microvascular decompression (MVD; Group 3, n = 59). Diagnosis was based on clinical criteria, high-resolution magnetic resonance imaging (MRI) and electroneuromyography (ENMG). Pain and QoL were assessed before and after treatment using institutional questionnaires.

Results. Positive outcomes were achieved in 163 of 171 patients (95.0%). The best results were obtained in Group 3 (MVD), where 87% of patients achieved significant improvement and none showed no change. Pain and QoL scores improved significantly in all groups after treatment (P < 0.001), most markedly after MVD.

Conclusion. A differentiated, severity- and comorbidity-based treatment strategy yields high rates of pain relief and QoL improvement in TN. MVD provides the most durable outcomes in surgically fit patients, while destructive and conservative approaches remain valuable for patients with contraindications to MVD.

Keywords:

trigeminal neuralgia, microvascular decompression, differentiated approach, disease severity, quality of life, facial pain

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