Largest study to date shows higher long-term pain relief and fewer complications than microvascular decompression
For patients searching for the most durable surgical treatment for trigeminal neuralgia, a clinical study of a technique developed at the University of California, San Francisco (UCSF)—known as contactless transposition—may offer some of the strongest long-term results reported to date.
Trigeminal neuralgia is a debilitating condition characterized by sudden, excruciating facial pain, often caused by a blood vessel compressing the trigeminal nerve. Eating, speaking, even feeling the wind against one’s face can cause shocks of pain so intense that many patients begin to organize their lives around avoiding them.
For decades, the standard surgical treatment has been microvascular decompression (MVD), which relieves pain by placing a small cushion, typically made of Teflon, between the offending blood vessel and the trigeminal nerve. The approach can be highly effective, but it is not always permanent. Over time, the material can shift, inflame surrounding tissue, or form granulomas—sometimes allowing the pain to return.
A New Surgical Technique for Trigeminal Neuralgia
At UCSF, Chair of Neurosurgery Edward F. Chang, MD, developed and refined the contactless transposition procedure to keep both the blood vessel and any implanted material from contacting the trigeminal nerve.
During the surgery, he uses a small strip of the patient’s own pericranium (a fibrous layer of scalp tissue) to create a sling that gently lifts the compressing blood vessel and anchors it away from the nerve.
“The goal was to move beyond simply padding the nerve, and instead completely and permanently decompress it,” said Chang. “By using the patient’s own tissue, we provide a more natural and robust solution that eliminates the risks associated with synthetic implants.”
A Journal of Neurosurgery study analyzing 305 patients treated at UCSF between 2015 and 2024 (the largest series to date evaluating this approach) found that:
- Over 90% of patients who underwent contactless transposition were pain-free at two years
- This compares to approximately 78% for traditional Teflon-based MVD
- The contactless approach eliminated inflammation or granulomas caused by implanted materials
- Patients experienced lower rates of postoperative numbness, a common and often distressing side effect of treatment
Compared with traditional microvascular decompression, contactless transposition with a pericranial sling provides more durable pain relief and fewer complications, making it the most definitive treatment for trigeminal neuralgia.
Expertise for Lasting Relief from Trigeminal Neuralgia
While the sling transposition is technically more demanding and requires a specialized surgical skillset, it has become a routine standard for Chang and his team. At many centers, traditional MVD with Teflon padding remains the standard approach.
The report in Journal of Neurosurgery demonstrates that for patients seeking the most durable, long-term relief from trigeminal neuralgia, this "contactless" biological approach represents a new benchmark in the field.
"This study confirms that we can achieve better, longer-lasting results by working with the body’s own anatomy," added Dr. Chang. "For patients who have lived in fear of their next pain episode, this technique can offer better peace of mind".
Accessing Expert Care for Facial Pain Disorders
UCSF also has in-depth expertise with Gamma Knife radiosurgery and radiofrequency ablation, which can be used to treat trigeminal neuralgia when medications have failed and transposition of the nerve is not an option.
UCSF offers in-person and telehealth evaluations for patients. To make an appointment or get a second opinion for treatment of trigeminal neuralgia, glossopharyngeal neuralgia, or atypical facial pain, contact:
UCSF Neurosurgery
Phone: (415) 353-7500
Fax: (415) 353-2889
Schedule online: Trigeminal Neuralgia Appointment Request Form
About UCSF Neurological Surgery
The UCSF Department of Neurosurgery is a world leader in treating complex brain and spinal cord disorders and has been the #1 NIH-funded neurosurgery program for over 20 years. Consistently ranked among the top neurosurgery programs in the nation, UCSF is at the forefront of developing innovative therapies for severe pain disorders, including trigeminal neuralgia.
Reference: Lee, A. T., Morshed, R. A., Kondapavulur, S., Caldwell, D. J., Nichols, N., Smith, G., Wang, A., Ward, M., Waung, M. W., Winkler, E., & Chang, E. F. (2025). Outcome comparison between interposition and "contactless" transposition microvascular decompression approaches for trigeminal neuralgia. Journal of Neurosurgery, 143(4), 970-981. https://doi.org/10.3171/2025.2.JNS241831