Microvascular decompression for recurrent trigeminal neuralgia |
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| Affiliation: | 1. Department of Neurosurgery, Rui Jin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China;2. Department of Neurosurgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, People’s Republic of China;1. Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA;2. College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA;1. Department of Neurosurgery, XinHua Hospital affiliated to Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China;2. Department of Neurosurgery, Catholic University School of Medicine, Largo A. Gemelli, Rome, Italy;1. Department of Neurosurgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China;2. Center for Diagnosis and Treatment of Cranial Nerve Diseases, Shanghai Jiao Tong University, Shanghai, China;3. Department of Neurosurgery, Affiliated Hospital of Zunyi Medical College, Guizhou, China;1. Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, China;2. Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China;3. Department of Neurosurgery, Dongying Second People''s Hospital, Dongying, Shandong, China;4. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA |
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| Abstract: | Recurrence of trigeminal neuralgia (TN) symptoms after microvascular decompression (MVD) is a challenge for neurosurgeons. This study evaluates the indication, efficacy and safety of re-do MVD. We retrospectively reviewed consecutive patients who underwent MVD for TN from January 2000 to June 2012. The parameters of study interest were pre-operative magnetic resonance tomographic angiography (MRTA) findings and operative findings. Pain outcome was scored using the Barrow Neurological Institute (BNI) grading scale. Twelve patients underwent re-do MVD following recurrence of pain. Vascular compression was detected on pre-operative MRTA images in eight patients, a small mass was found in two patients, and pre-operative imaging was negative in two patients. Of the eight patients with a positive finding of arterial conflict, a vascular loop was identified intra-operatively in five patients (62.5%); in two (25.0%) a small granuloma filled with Teflon fibers was found compressed the trigeminal nerve; and in one patient (12.5%) only dense arachnoid adhesions were found around the trigeminal nerve. For the two patients with mass compression on MRTA images, a granuloma was found during operation. Neurovascular compression was found in the two patients with negative preoperative MRTA images. Re-do MVD is a safe and effective treatment for recurrent TN when indicated by a prolonged pain-free period following the first surgery. |
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| Keywords: | Granuloma Microvascular decompression Re-do surgery Trigeminal neuralgia |
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