Wrap technique for idiopathic trigeminal neuralgia: patient series.

Background: Idiopathic trigeminal neuralgia (TN) presents significant diagnostic and therapeutic challenges. While microvascular decompression (MVD) is well established for classic TN, its role in idiopathic cases remains controversial due to the absence of an identifiable neurovascular conflict and lack of clear anatomical target. New strategies are needed to address this challenging patient population.

Observations: Six patients with idiopathic TN underwent MVD with a Teflon wrap placed around the trigeminal nerve. All had undergone high-resolution MRI (CISS or FIESTA sequence), and intraoperative exploration was negative for a neurovascular conflict. Intraoperative trigeminal-hypoglossal reflex (THR) monitoring was used as a functional marker of decompression. All patients exhibited intact THR at baseline and complete loss of THR after wrap placement, indicating adequate decompression. Preoperative Barrow Neurological Institute pain scores (BNI-PSs) ranged from III to V. Five patients achieved sustained pain relief (BNI-PS of 0 or I) by postoperative day 1. One patient experienced delayed improvement but progressed from BNI-PS IV to 0 by 6 months. All patients remained pain free at 18 months.

Lessons: A Teflon wrap technique with intraoperative THR monitoring may represent a safe and effective surgical option for idiopathic TN. By addressing potential biomechanical or dynamic nerve dysfunction, this approach offers meaningful pain relief even in the absence of a visible vascular conflict. https://thejns.org/doi/10.3171/CASE25348.