OBJECT: To summarize our experience in treating veins during microvascular decompression (MVD) procedures for idiopathic trigeminal neuralgia (TN). METHODS: A total of 210 patients who underwent single MVD for idiopathic TN were retrospectively studied. The offending vessels were summarized. The treatment choices for veins during the operation were reviewed. Postoperative long-term outcomes were determined by follow-up. RESULTS: Veins accounted for 26.7% of the total 262 offending vessels. Neurovascular conflicts were caused by veins alone in 23 patients (11.2%), and they were caused by arteries and veins together in 47 patients (22.8%). The offending veins were cut (15.7%) or saved (84.3%) during the operation. Excellent long-term outcomes were acquired in 78.3% of the patients with venous type TN. CONCLUSION: There are no acknowledged principles guiding the treatment of veins during MVD. Our primary treatment principle is to retain veins as often as possible.
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