Efficacy of epineurial incision for trigeminal neuralgia without neurovascular compression: Intraneural decompression and morphological restoration

Background: Trigeminal neuralgia (TN) is most commonly caused by neurovascular compression; however, a subset of patients present without identifiable vascular contact, for whom the optimal surgical strategy remains controversial. Methods: Between February 2022 and August 2025, 157 patients underwent microsurgical treatment for TN at our institution. This study represents a retrospective analysis of a prospectively maintained surgical database. Thirty patients without radiological or intraoperative evidence of neurovascular compression were treated with superficial epineurial incision. Pain outcomes were evaluated using the Barrow Neurological Institute (BNI) pain intensity scale, and postoperative complications were assessed. Results: Immediate postoperative pain relief (BNI I-II) was achieved in all patients. At 12 months, 27 (90%) patients maintained favorable outcomes. Recurrence was defined as deterioration to BNI grade III or higher requiring additional medication or reintervention; 3 (10%) patients met this definition. Transient facial numbness occurred in 3 (10%) patients and resolved within 3 months. No permanent dysesthesia, anesthesia dolorosa, or corneal complications were observed. Conclusion: In this exploratory retrospective case series, superficial epineurial incision was feasible and associated with favorable short-term pain control with limited sensory morbidity in carefully selected patients with classical TN without neurovascular compression. Interpretation of these findings should be made in the context of the baseline, and further studies with larger cohorts and longer follow-up are required.