title: Repeat microvascular decompression for recurrent idiopathic trigeminal neuralgia.
abstract: OBJECTIVE
  Microvascular decompression (MVD) is considered the method of choice to treat idiopathic trigeminal neuralgia (TN) refractory to medical treatment. However, repeat MVD for recurrent TN is not well established. In this paper, the authors describe a large case series in which patients underwent repeat MVD for recurrent TN, focusing on outcome, risk factors, and complication rates.
  
  
  METHODS
  Between 1990 and 2012, a total of 33 consecutive patients underwent repeat MVD for recurrent TN at the University Medical Center Groningen. The authors performed a retrospective chart review and telephone interviews. Risk factors were analyzed by binary logistic regression analysis.
  
  
  RESULTS
  After 12 months of follow-up, 22 (67%) operations were successful, of which 19 patients were completely free of pain without medication. With multivariate analysis significant risk factors for success were older age (OR 1.11, p < 0.01) and direct absence of pain after repeat MVD (OR 25.2, p < 0.01). Previous neurodestructive procedures did not influence success rates. Facial numbness occurred in 9 patients (27%), while other morbidity was minimal. There was no mortality.
  
  
  CONCLUSIONS
  This study demonstrates that repeat MVD is a feasible therapeutic option with good chances of success, even in patients who have undergone neurodestructive procedures. Complication rates, particularly facial numbness, can be avoided if only a limited neurolysis is performed.
authors.affiliation: Department of Neurosurgery, University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: Nicolaas A
authors.initials: NA
authors.lastname: Bakker
authors.forename: J Marc C
authors.initials: JM
authors.lastname: Van Dijk
authors.forename: Steven
authors.initials: S
authors.lastname: Immenga
authors.forename: Michiel
authors.initials: M
authors.lastname: Wagemakers
authors.forename: Jan D M
authors.initials: JD
authors.lastname: Metzemaekers
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D061145:Microvascular Decompression Surgery / Q000009:adverse effects; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000601:surgery*; D055815:Young Adult
keywords: MVD = microvascular decompression; Sweet procedure; TN = trigeminal neuralgia; functional neurosurgery; microvascular decompression; pain; recurrent; trigeminal neuralgia