{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T16:56:16Z","timestamp":1792515376876,"version":"4.5.0"},"reference-count":68,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Although trigeminal neuralgia (TN) is initially managed conservatively, approximately half of all patients will eventually undergo surgery. Despite this outcome, there is limited understanding of the relationship between preoperative length of conservative management and pain outcomes after microvascular decompression (MVD). In this study, the authors aimed to describe the relationship between the duration of preoperative conservative management and postoperative outcomes in patients undergoing MVD for TN.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The electronic medical records of 381 patients with TN who underwent primary MVD at the authors\u2019 institution between 2007 and 2023 were reviewed. Patients were dichotomized based on whether the duration of conservative management, defined as the duration of anticonvulsant use, was greater than, or less than or equal to, the median duration of conservative management for the entire cohort. For adjusted analysis, duration of conservative management was also assessed as a continuous variable. Demographic information, comorbidities, clinical TN characteristics, pain recurrence, and pre- and postoperative modified Barrow Neurological Institute (BNI) pain and numbness scale scores were recorded and compared between groups. Differences in pain outcomes were assessed via multivariate ordinal regression, Kaplan-Meier analysis, and Cox proportional hazards analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The median preoperative duration of conservative management was 1.74 years. Patients with a prolonged duration of conservative management were significantly more likely to be male (p = 0.028) and less likely to preoperatively use opioids (p = 0.037). At final follow-up, those with a prolonged duration of conservative management had significantly higher reported BNI pain scores (p = 0.021) and higher rates of pain recurrence (p = 0.021). On multivariable ordinal regression analysis, younger age (p &lt; 0.001) and prolonged duration of conservative management, which was assessed as both a dichotomized (p = 0.002) and continuous variable (p = 0.011), were associated with higher BNI pain scores at final follow-up. Patients with a longer duration of conservative management also had a significantly shorter time to pain recurrence, as assessed by Kaplan-Meier survival analysis (p = 0.0037) as well as Cox proportional hazards analysis (p = 0.001, dichotomized; p = 0.008, continuous).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>In the setting of primary MVD for patients with TN, a longer duration of preoperative conservative management was associated with higher postoperative BNI pain scores and increased risk of pain recurrence. These findings suggest a potential beneficial role for early surgical intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.9.jns241436","type":"journal-article","created":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T20:35:34Z","timestamp":1738960534000},"page":"92-99","source":"Crossref","is-referenced-by-count":4,"title":["Effects of the length of preoperative conservative management on postoperative outcomes after primary microvascular decompression for trigeminal neuralgia"],"prefix":"10.3171","volume":"143","author":[{"given":"Anita L.","family":"Kalluri","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emeka","family":"Ejimogu","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sai","family":"Chandan Reddy","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumil K.","family":"Nair","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hussain","family":"Alkhars","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Collin","family":"Kilgore","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mostafa","family":"Abdulrahim","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivek","family":"Yedavalli","sequence":"additional","affiliation":[{"name":"Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher M.","family":"Jackson","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judy","family":"Huang","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chetan","family":"Bettegowda","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Risheng","family":"Xu","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"Clin Radiol","first-page":"203","article-title":"The trigeminal nerve: an illustrated review of its imaging anatomy and pathology","volume":"68","author":"Bathla G","year":"2013","unstructured":"Bathla G, Hegde AN. The trigeminal nerve: an illustrated review of its imaging anatomy and pathology. Clin Radiol. 2013;68(2):203\u2013213."},{"issue":"5","key":"b2","series-title":"Eur J Pain","first-page":"580","article-title":"Incidence of trigeminal neuralgia: a population-based study in Central Sweden","volume":"27","author":"Svedung Wettervik T","year":"2023","unstructured":"Svedung Wettervik T, Snel D, Kristiansson P, Ericson H, Abu Hamdeh S. Incidence of trigeminal neuralgia: a population-based study in Central Sweden. Eur J Pain. 2023;27(5):580\u2013587."},{"issue":"3","key":"b3","series-title":"Expert Rev Neurother","first-page":"323","article-title":"Update on trigeminal neuralgia","volume":"9","author":"Obermann M","year":"2009","unstructured":"Obermann M, Katsarava Z. Update on trigeminal neuralgia. Expert Rev Neurother. 2009;9(3):323\u2013329."},{"issue":"8","key":"b4","series-title":"N Engl J Med","first-page":"754","article-title":"Trigeminal neuralgia","volume":"383","author":"Cruccu G","year":"2020","unstructured":"Cruccu G, Di Stefano G, Truini A. Trigeminal neuralgia. N Engl J Med. 2020;383(8):754\u2013762."},{"issue":"2","key":"b5","series-title":"Neurosciences (Riyadh)","first-page":"107","article-title":"Update on neuropathic pain treatment for trigeminal neuralgia. The pharmacological and surgical options","volume":"20","author":"Al-Quliti KW","year":"2015","unstructured":"Al-Quliti KW. Update on neuropathic pain treatment for trigeminal neuralgia. The pharmacological and surgical options. Neurosciences (Riyadh). 2015;20(2):107\u2013114."},{"issue":"1","key":"b6","series-title":"Clin Anat","first-page":"89","article-title":"The anatomy of vascular compression in trigeminal neuralgia","volume":"27","author":"Thomas KL","year":"2014","unstructured":"Thomas KL, Vilensky JA. The anatomy of vascular compression in trigeminal neuralgia. Clin Anat. 2014;27(1):89\u201393."},{"key":"b7","series-title":"Mult Scler Relat Disord","first-page":"103472","article-title":"Prevalence of trigeminal neuralgia in multiple sclerosis: a systematic review and meta-analysis","volume":"57","author":"Houshi S","year":"2022","unstructured":"Houshi S, Tavallaei MJ, Barzegar M,  Prevalence of trigeminal neuralgia in multiple sclerosis: a systematic review and meta-analysis. Mult Scler Relat Disord. 2022;57:103472."},{"key":"b8","series-title":"J Pain Res","first-page":"3437","article-title":"Trigeminal neuralgia: current approaches and emerging interventions","volume":"14","author":"Xu R","year":"2021","unstructured":"Xu R, Xie ME, Jackson CM. Trigeminal neuralgia: current approaches and emerging interventions. J Pain Res. 2021;14:3437\u20133463."},{"issue":"10","key":"b9","series-title":"Biomedicines","first-page":"2606","article-title":"Therapeutic approach for trigeminal neuralgia: a systematic review","volume":"11","author":"Rana MH","year":"2023","unstructured":"Rana MH, Khan AAG, Khalid I,  Therapeutic approach for trigeminal neuralgia: a systematic review. Biomedicines. 2023;11(10):2606."},{"issue":"5","key":"b10","series-title":"Pract Neurol","first-page":"392","article-title":"Trigeminal neuralgia: a practical guide","volume":"21","author":"Lambru G","year":"2021","unstructured":"Lambru G, Zakrzewska J, Matharu M. Trigeminal neuralgia: a practical guide. Pract Neurol. 2021;21(5):392\u2013402."},{"issue":"9","key":"b11","series-title":"Lancet Neurol","first-page":"784","article-title":"Advances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgia","volume":"19","author":"Bendtsen L","year":"2020","unstructured":"Bendtsen L, Zakrzewska JM, Heinskou TB,  Advances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgia. Lancet Neurol. 2020;19(9):784\u2013796."},{"issue":"5","key":"b12","series-title":"J Korean Neurosurg Soc","first-page":"615","article-title":"Surgical treatment for trigeminal neuralgia","volume":"65","author":"Park CK","year":"2022","unstructured":"Park CK, Park BJ. Surgical treatment for trigeminal neuralgia. J Korean Neurosurg Soc. 2022;65(5):615\u2013621."},{"issue":"1","key":"b13","series-title":"Neurol Clin","first-page":"107","article-title":"Trigeminal neuralgia: diagnosis and treatment","volume":"41","author":"Allam AK","year":"2023","unstructured":"Allam AK, Sharma H, Larkin MB, Viswanathan A. Trigeminal neuralgia: diagnosis and treatment. Neurol Clin. 2023;41(1):107\u2013121."},{"issue":"2","key":"b14","series-title":"Curr Neurol Neurosci Rep","first-page":"125","article-title":"Surgical management of medically refractory trigeminal neuralgia","volume":"12","author":"Pollock BE","year":"2012","unstructured":"Pollock BE. Surgical management of medically refractory trigeminal neuralgia. Curr Neurol Neurosci Rep. 2012;12(2):125\u2013131."},{"issue":"2","key":"b15","series-title":"J Neurol","first-page":"532","article-title":"Microvascular decompression for trigeminal neuralgia in the elderly: efficacy and safety","volume":"268","author":"Greve T","year":"2021","unstructured":"Greve T, Tonn JC, Mehrkens JH. Microvascular decompression for trigeminal neuralgia in the elderly: efficacy and safety. J Neurol. 2021;268(2):532\u2013540."},{"issue":"3","key":"b16","series-title":"J Neurosurg","first-page":"359","article-title":"Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia","volume":"71","author":"Bederson JB","year":"1989","unstructured":"Bederson JB, Wilson CB. Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia. 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Trigeminal neuralgia: a practical guide. Pract Neurol. 2021;21(5):392\u2013402."},{"issue":"9","key":"b11","series-title":"Lancet Neurol","first-page":"784","article-title":"Advances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgia","volume":"19","author":"Bendtsen L","year":"2020","unstructured":"Bendtsen L, Zakrzewska JM, Heinskou TB,  Advances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgia. Lancet Neurol. 2020;19(9):784\u2013796."},{"issue":"5","key":"b12","series-title":"J Korean Neurosurg Soc","first-page":"615","article-title":"Surgical treatment for trigeminal neuralgia","volume":"65","author":"Park CK","year":"2022","unstructured":"Park CK, Park BJ. Surgical treatment for trigeminal neuralgia. 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Curr Neurol Neurosci Rep. 2012;12(2):125\u2013131."},{"issue":"2","key":"b15","series-title":"J Neurol","first-page":"532","article-title":"Microvascular decompression for trigeminal neuralgia in the elderly: efficacy and safety","volume":"268","author":"Greve T","year":"2021","unstructured":"Greve T, Tonn JC, Mehrkens JH. Microvascular decompression for trigeminal neuralgia in the elderly: efficacy and safety. J Neurol. 2021;268(2):532\u2013540."},{"issue":"3","key":"b16","series-title":"J Neurosurg","first-page":"359","article-title":"Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia","volume":"71","author":"Bederson JB","year":"1989","unstructured":"Bederson JB, Wilson CB. Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia. 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