Independent Predictors of Surgical View Obstruction in Microvascular Decompression for Trigeminal Neuralgia: A Multifactorial Analysis

Introduction: Microvascular decompression (MVD) is an effective surgical treatment for trigeminal neuralgia (TGN), but intraoperative anatomical variations may obstruct the surgical view and complicate exposure of the neurovascular conflict (NVC). While suprameatal tubercle (SMT) enlargement is a known cause of surgical view obstruction (SVO), other contributory factors remain underexplored. This study investigates the additional anatomical and technical factors associated with SVO during MVD and examines whether SVO affects postoperative pain outcomes. Methods A retrospective review was conducted on 95 patients who underwent MVD for TGN between January 2015 and June 2024. Demographic data, radiographic findings, intraoperative variables, and pain scores were analyzed. Univariate and multivariate statistical analyses were performed to identify factors associated with SVO and postoperative pain relief. Results SVO was observed in 15 patients (15.79%). Multivariate logistic regression identified three independent predictors of SVO: SMT enlargement (p < 0.001), presence of a dolichoectatic vertebrobasilar artery (p = 0.040), and sitting surgical position (p = 0.019). Although SVO was associated with a significantly longer operative time (p = 0.024), it did not adversely affect short-term pain relief (p = 0.901). Conclusion SVO during MVD for TGN is multifactorial and not limited to SMT enlargement. Dolichoectatic vascular anatomy and the sitting surgical position also contribute significantly to SVO. Thorough preoperative imaging and individualized intraoperative strategies are essential for optimizing visualization and improving surgical efficiency.