title: Unusual recurrence of trigeminal neuralgia after microvascular decompression by muscle interposal.
abstract: BACKGROUND
  Patients with trigeminal neuralgia (TN) and persistent or recurrent facial pain after microvascular decompression (MVD) typically undergo less invasive procedures in the hope of providing pain relief. However, re-operation should be considered in selected patients.
  
  
  METHODS
  A 48-year-old woman presented with recurrent trigeminal neuralgia (TN) 3 years following microvascular decompression (MVD). The patient underwent brain magnetic resonance angiography (MRA), which did not reveal neurovascular compression; therefore surgical re-exploration was carried out. During the operation, the fifth cranial nerve was seen without impingement from any blood vessels; however, a very firm tissue was observed and identified as the muscle fragment from the previous MVD procedure. The fifth cranial nerve was carefully separated from the muscle. Thereafter, the right SCA was dissected out from the muscle and suspended by a periosteum tape sutured to the nearby dura.
  
  
  CONCLUSIONS
  Our findings, along with similar cases reported in the literature, support the development of new inert materials and alternative surgical strategies that can limit TN recurrence.
authors: Neurosurgical Clinic, Department of Clinic Neurosciences, University of Palermo, Palermo, Italy. ggrasso@unipa.it
authors: Giovanni
authors: G
authors: Grasso
authors: Franceso
authors: F
authors: Meli
authors: Rosario
authors: R
authors: Maugeri
authors: Francesco
authors: F
authors: Certo
authors: Gabriele
authors: G
authors: Costantino
authors: Filippo
authors: F
authors: Giambartino
authors: Domenico G
authors: DG
authors: Iacopino
mesh_terms: D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D055806:Microvessels / Q000601:surgery*; D008875:Middle Aged; D009132:Muscles / Q000601:surgery*; D011859:Radiography; D012008:Recurrence; D014277:Trigeminal Neuralgia / Q000000981:diagnostic imaging / Q000601:surgery*