Abstract

Introduction: Microvascular decompression (MVD) is a well-accepted technique for the surgical management of various cranial neuropathies. While many studies have examined the outcomes of MVD in single-center trials, we sought to determine the re- operation rate in a large, independent cohort of patients undergoing MVD surgery. Methods: The Reuter’s MarketScan database was utilized to perform a retrospective, population-based study. Patients who underwent MVD for trigeminal neuralgia, hemifacial spasm or glossopharyngeal neuralgia between 2000 and 2009. Of the 278 MVD procedures identified, all patients with less than 2 years of post-operative follow-up data were excluded. The records of the remaining 113 patients were analyzed using a logistic regression analysis examining long-term complication and re-operation rates, type of re-operation and outpatient healthcare resource utilization. Results: The study sample included 278 patients with a total of 113 patients with >2 year follow-up. The mean age was 56 years, 67% female, 68% Commercial insurance, 87% with low comorbidities (Charlson index= 0) and mean follow-up of 4 years. The 1, 2 and long-term re-operation rates were 2.7%, 3.5% and 4.4%, respectively. Post-operative complications totaled 8.0% at 90 days. Re-operation consisted of redo MVD (3.5%), balloon decompression (1.8%), and radiosurgery (0.88%). Average time to re-operation was 3.8 years and 2 year follow-up resulted in hospital charges totaling $9018, outpatient services of $9384, and medication charges of $4906. Conclusions: In this large, retrospective study, MVD remains a robust procedure that is well-tolerated. Repeat MVD remains the first- line choice for those requiring re-operation, however these patients continue to require significant healthcare resources.