Recurrent or refractory trigeminal neuralgia after microvascular decompression, radiofrequency ablation, or radiosurgery.
OBJECTIVE
Trigeminal neuralgia (TN) is characterized by paroxysmal lancinating pain in the trigeminal nerve distribution. When TN is refractory to medical management, patients are referred for microvascular decompression (MVD), radiofrequency ablation, or radiosurgery. After the initial treatment, patients may have refractory or recurrent symptoms requiring retreatment. The purpose of this study was to determine what factors are associated with the need for retreatment and which modality is most effective.


METHODS
To define this population further, the authors evaluated a cohort of patients who required retreatment for TN. The mean follow-up periods were 51 months from the first treatment and 23 months from the last one, and these were comparable among treatment groups.


CONCLUSIONS
Trigeminal neuralgia can recur after neurosurgical treatment. In this study the authors demonstrate that the number of patients requiring retreatment is not negligible. Lower retreatment rates were seen in patients who initially underwent radiosurgery, compared with those in whom MVD or radiofrequency ablation were performed. Radiosurgery was more likely to be the final treatment for recurrent TN regardless of the initial treatment. After retreatment, the majority of patients attained complete or very good pain relief. Pain relief after retreatment correlates with postoperative facial numbness.
Sanchez-Mejia
Rene O
RO
Department of Neurological Surgery, University of California, San Francisco 94143-0112, USA.
Limbo
Mary
M
Cheng
Jason S
JS
Camara
Joaquin
J
Ward
Mariann M
MM
Barbaro
Nicholas M
NM
D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D019299:Decompression, Surgical / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D016634:Radiosurgery / Q000706:statistics & numerical data*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000453:epidemiology / Q000601:surgery*