Management of Arachnoid Nerve Tethering in Trigeminal Neuralagia

This study aims to evaluate the clinical significance of arachnoid-trigeminal nerve conflict in patients with medically refractory trigeminal neuralgia without demonstrable neurovascular conflict on preoperative magnetic resonance imaging (MRI). Patients undergoing surgical exploration will be assessed clinically, radiologically, and intraoperatively for the presence and characteristics of arachnoid adhesions or tethering involving the trigeminal nerve. Endoscopic-assisted arachnoid release will be performed when appropriate. Postoperative pain outcome will be evaluated using the Barrow Neurological Institute (BNI) pain intensity score and the Visual Analog Scale (VAS). Recurrence, postoperative complications, MRI-intraoperative correlation, and potential predictors of favorable surgical outcome will also be evaluated.