title: Microvascular decompression for recurrent trigeminal neuralgia.
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.
authors.affiliation: Department of Neurosurgery, Rui Jin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
authors.forename: Weiting
authors.initials: W
authors.lastname: Gu
authors.affiliation: Department of Neurosurgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, People's Republic of China. Electronic address: rjzhaoweiguo@gmail.com.
authors.forename: Weiguo
authors.initials: W
authors.lastname: Zhao
mesh_terms: D000328:Adult; D002533:Cerebral Angiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D061145:Microvascular Decompression Surgery / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D010147:Pain Measurement; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000473:pathology / Q000601:surgery*
keywords: Granuloma; Microvascular decompression; Re-do surgery; Trigeminal neuralgia