Documented preoperative depression is not significantly associated with pain outcomes following microvascular decompression for Type 1 trigeminal neuralgia.

BACKGROUND: Depression is a common comorbidity among patients with trigeminal neuralgia (TN). Although microvascular decompression (MVD) provides durable pain relief for medically refractory TN, prior studies have associated depression with poorer outcomes in heterogeneous TN cohorts. Whether this relationship exists specifically in Type 1 TN (TN1) remains unclear. This study evaluated whether documented preoperative depression was associated with early or long-term pain outcomes following MVD for TN1. METHODS: We retrospectively reviewed MVD procedures performed for classical TN1 at a single academic institution between 2016 and 2025. Depression status was determined by retrospective review of documented diagnoses in the electronic medical record at the time of surgery. Primary outcomes included pain relief at first, last, and long-term (>1 year) follow-up using the Barrow Neurological Institute (BNI) scale, with BNI IIIb-V considered inadequate pain relief. Time-to-recurrence was evaluated using Cox and Kaplan-Meier analysis. RESULTS: Among 289 MVD procedures, median follow-up was 7.16 months [IQR: 0.66-33.6]; among 131 patients with >1 year follow-up, median follow-up was 35.3 months [IQR: 22.9-61.2]. Forty-nine patients (17.0%) had documented depression. Patients with documented depression were younger (p < 0.001) and more often female (p = 0.004). Adequate pain relief at first, last, and long-term follow-up did not differ by documented depression status (p = 1.00, p = 0.794, and p = 0.471, respectively). Recurrence-free pain relief was similar between patients with and without documented depression (p = 0.723). CONCLUSION: This study did not identify a statistically significant association between documented preoperative depression and postoperative pain outcomes following MVD for TN1. Given its prevalence, depression remains an important consideration in TN care.