[Management of recurrent trigeminal neuralgia after failed microvascular decompression].
OBJECTIVE
To evaluate the surgical management of patients with trigeminal neuralgia after failed microvascular decompression.


METHODS
Between 1993 and 2002, exploration of the posterior fossa was performed in 60 patients with trigeminal neuralgia. Records were analyzed retrospectively for those patients who needed another surgical procedure due to recurrence of pain, describing which procedure was performed, postoperative results and complications, and also the intraoperative findings when posterior fossa reexploration was realized.


RESULTS
Eighteen patients had trigeminal neuralgia recurrence requiring a new surgical intervention, that consisted in a fossa posterior reexploration in nine patients and percutaneous radiofrequency termal rhizotomy in the other nine patients. Among the repeat operations, there was negative exploration in 7 patients (77%), and a partial sensory rhizotomy was performed. Most of thermocoagulations (5/9) were performed in old patients or patients with anestesic contraindication for the fossa posterior reexploration.


CONCLUSIONS
Fossa posterior reexploration is an effective and safe surgical attitude in the treatment of recurrent trigeminal neuralgia after failed microvascular decompression. Partial sensory rhizotomy is recommended when the reexploration is negative.
Fernández-Carballal
C
C
Servicio de Neurocirugía, Hospital General Universitario Gregorio Marañón, Madrid.
García-Salazar
F
F
Pérez-Calvo
J
J
García-Leal
R
R
Gutiérrez
F A
FA
Carrillo
R
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D012189:Retrospective Studies; D017211:Treatment Failure; D014276:Trigeminal Nerve / Q000098:blood supply; D014277:Trigeminal Neuralgia / Q000601:surgery*
Manejo de la recidiva de la neuralgia del trigémino tras descompresión microvascular.