REOPERATION FOR RECURRENT TRIGEMINAL NEURALGIA AFTER MICROVASCULAR DECOMPRESSION

BACKGROUND Microvascular decompression (MVD) is an effective technique for those who have trigeminal neuralgia (TN) but cannot tolerate, or show no response to medicine, Though the initial success rate is high, some patients may develop severe recurrent neuralgia, especially afte r a longer period of follow-up. The efficacy of reoperation needs to b e evaluated. To know the possible risk factors of recurrence after ini tial MVD is mandatory to the management of recurrent TN. METHODS Among the 80 cases of TN treated with MVD, five cases showed severe recurre nt symptoms within a follow-up period from 9 months-4 years. The sympt oms recurred on the same side of the face, and were unresponsive to me dical treatment. Brain computed tomography (CT) and magnetic resonance imaging (MRI) may reveal the etiology of recurrence. Repeat decompres sion of the trigeminal nerve was the main goal of reoperation, which w as done via a suboccipital approach. RESULTS Over the past 17 years, 8 0 MVDs for TN have been performed at Chang Gung Memorial Hospital. The re were five cases of serious postoperative recurrence, which could no t be relieved by medicine. Recurrence occurred 1 day-12 months after t he initial surgery. Three cases were due to vascular compression, whil e two were caused by the local effect of Teflon felt. Reoperation prod uced complete remission in four patients, and partial remission in one . CONCLUSIONS An increasing number of patients may experience severe r ecurrent TN after initial MVD during a long period of follow-up. Reope ration is safe and beneficial for these patients, but the results are dependent on the etiology of the recurrence. Further vascular compress ion of the trigeminal nerve can be relieved by MVD. Otherwise, in case s of severe adhesion caused by Teflon, complete microneural lysis can achieve satisfactory results. (C) 1997 by Elsevier Science Inc.