title: A Clinical Analysis of Secondary Surgery in Trigeminal Neuralgia Patients Who Failed Prior Treatment.
abstract: OBJECTIVE
  Although many treatment modalities have been introduced for trigeminal neuralgia (TN), the long-term clinical results remain unsatisfactory. It has been particularly challenging to determine an appropriate treatment strategy for patients who have responded poorly to initial therapies. We analyzed the surgical outcomes in TN patients who failed prior treatments.
  
  
  METHODS
  We performed a retrospective analysis of 37 patients with recurrent or persistent TN symptoms who underwent surgery at our hospital between January 2010 and December 2014. Patients with follow-up data of at least one year were included. The prior treatment modalities of the 37 patients included microvascular decompression (MVD), gamma knife radiosurgery (GKRS), and percutaneous procedures such as radiofrequency rhizotomy (RFR), balloon compression, and glycerol rhizotomy (GR). The mean follow-up period was 69.9 months (range : 16-173). The mean interval between the prior treatment and second surgery was 26 months (range : 7-123). We evaluated the surgical outcomes using the Barrow Neurological Institute (BNI) pain intensity scale.
  
  
  RESULTS
  Among the 37 recurrent or persistent TN patients, 22 underwent MVD with partial sensory rhizotomy (PSR), 8 received MVD alone, and 7 had PSR alone. Monitoring of the surgical treatment outcomes via the BNI pain intensity scale revealed 8 (21.6%) patients with a score of I, 13 (35.1%) scoring II, 13 (35.1%) scoring III, and 3 (8.2%) scoring IV at the end of the follow-up period. Overall, 91.8% of patients had good surgical outcomes. With regard to postoperative complications, 1 patient had transient cerebrospinal fluid rhinorrhea (2.7%), another had a subdural hematoma (2.7%), and facial sensory changes were noted in 8 (21.1%) patients after surgery.
  
  
  CONCLUSIONS
  Surgical interventions, such as MVD and PSR, are safe and very effective treatment modalities in TN patients who failed initial or prior treatments. We presume that the combination of MVD with PSR enabled us to obtain good short- and long-term surgical outcomes. Therefore, aggressive surgical treatment should be considered in patients with recurrent TN despite failure of various treatment modalities.
authors.affiliation: Department of Neurosurgery, Kyung Hee University College of Medicine, Seoul, Korea.
authors.forename: Il Ho
authors.initials: IH
authors.lastname: Kang
authors.affiliation: Department of Neurosurgery, Kyung Hee University College of Medicine, Seoul, Korea.
authors.forename: Bong Jin
authors.initials: BJ
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Kyung Hee University College of Medicine, Seoul, Korea.
authors.forename: Chang Kyu
authors.initials: CK
authors.lastname: Park
authors.affiliation: Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea.
authors.forename: Hridayesh Pratap
authors.initials: HP
authors.lastname: Malla
authors.affiliation: Department of Neurosurgery, Kyung Hee University College of Medicine, Seoul, Korea.
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Kyung Hee University College of Medicine, Seoul, Korea.
authors.forename: Bong Arm
authors.initials: BA
authors.lastname: Rhee
keywords: Microvascular decompression; Rhizotomy; Trigeminal neuralgia