Current practice patterns in microvascular decompression for trigeminal neuralgia: results from an international survey

Background Trigeminal neuralgia is a facial pain disorder, most often caused by neurovascular contact at the trigeminal root. In cases refractory to pharmacotherapy, microvascular decompression (MVD) is an established treatment. Since its description, various modifications have been introduced. The extent to which current practice deviates from the original approach remains unclear. This study aimed to assess current strategies in MVD for trigeminal neuralgia. Methods A web-based 14-item questionnaire was distributed to neurosurgeons with expertise in MVD from Germany, Austria, Switzerland, Italy, and Luxembourg. The link to the survey was shared between May and August 2025 and was not made public. To avoid institutional clustering, only one practitioner per institution was invited to participate anonymously. Results Of 123 neurosurgeons invited, 63 completed the questionnaire (response rate 51.2%). 93.7% of respondents do not consider an age limit for MVD. Surgery is most commonly performed in the supine (46.0%) or lateral (39.7%) position, either purely microscopically (65.1%) or with endoscopic assistance (30.2%). 71.4% of practitioners regularly use neuromonitoring. Trepanation is usually performed either osteoplastically or osteoclastically with Palacos cranioplasty (36.5% each). Teflon is the most frequently used interposition material (74.6%). 65.1% never sacrifice the superior petrosal vein. Only 7.9% would generally refrain from MVD if no neurovascular contact is evident on radiological examination. Conclusion This survey demonstrates current practice patterns in MVD for trigeminal neuralgia in central Europe. While some principles of the original technique remain widely adopted, notable changes in operative strategy are apparent, highlighting areas for future consensus-building and research, and informing operative decision-making.