gms | German Medical Science

Objective: Microvascular decompression (MVD) is a well-accepted treatment modality for trigeminal neuralgia (TN). The initial success rate is high, however, in a subset of patients TN might recur in the long-term. Recurrent TN after MVD might be due to several causes and treatment algorithms remain unclear. Here, we present the surgical findings and clinical outcome of patients with recurrent TN after MVD who underwent microsurgical re-decompression.

Methods: Twenty-seven patients with recurrent TN who underwent microsurgical re-decompression over a period of 10 years were analysed. There were 14 women (54%) and 13 men (46%) with a mean age of 60 years (range, 35-82 years). Patients with multiple sclerosis were excluded. All patients had magnetic resonance imaging before surgery. Microsurgical re-decompression included dissection of the previously inserted Teflon and of scar tissue avoiding any damage to the trigeminal nerve. In no case the trigeminal nerve was lesioned, "combed" or dissected. New Teflon felt was placed in case an offending artery was found. There was no operative morbidity or mortality. All patients were available for postoperative follow-up. The outcome of the repeat intervention was graded according to the Barrow Neurological Institute (BNI) Pain intensity score. Follow-up was analysed postoperatively at 3, 12 and 24 months and at long-term (mean 48.1 months).

Results: Recurrent TN was associated with the following findings as identified intraoperatively: arachnoid adhesions/scar tissue at the trigeminal entry zone (23/27), deformation of the trigeminal nerve/Tefloma (14/27), new nerve/vein contact (15/27), new nerve/artery contact with marked pulsations (1/27) and compression of the trigeminal nerve by the electrode in cavum Meckeli used for treatment of neuropathic pain (1/27). 23/27 patients had a combination of findings. Early postoperative pain relief was achieved in all patients. 23 patients were available for 24- month follow-up or longer. Of these, 16/23 patients (69%) had BNI I, 5/23 patients (22%) had BNI IIIa, and 2 patients (9%) had a BNI pain score of IV or V.

Conclusion: Microsurgical re-decompression was highly successful for recurrent TN. There were no serious side effects and the frequency of postoperative hypaesthesia was low. We conclude that microsurgical re-decompression completely preserving the trigeminal nerve is a feasible and beneficial treatment option in this context. Manoeuvres such as dissecting or combing the trigeminal nerve may be avoided.