REPEAT OPERATIONS IN FAILED MICROVASCULAR DECOMPRESSION FOR TRIGEMINAL NEURALGIA

FOR THE STUDY of pathogenesis and treatment of recurrent trigeminal ne uralgia, we performed 31 repeat operations from among 400 patients wit h trigeminal neuralgia in the past 10 years. Initially, of these 400 p atients, 376 underwent microvascular decompression only, and 24 underw ent partial sensory rhizotomy with or without microvascular decompress ion. Fifty-three patients (14%) had recurrences after microvascular de compression, of which 31 patients underwent repeat operations. Among t he repeat operations, there was negative exploration in 16 patients (5 2%), arterial loop compression in 7 (22%), venous compression in 4 (13 %), and Teflon compression or adhesion in 4 (13%). Twenty-one patients had early recurrences within 1 year, and 10 patients had late recurre nces. Negative exploration and arterial compression were move likely i n early recurrence (P = 0.01). Continuing demyelination might occur in patients with negative exploration, even when adequate decompression had been initially performed. Seventy percent of the patients had no r ecurring pain by way of partial sensory rhizotomy for negative explora tions, redecompression of arterial loops, division of offending veins, or lysis and reposition of Teflon. About half of the patients had pos itive findings that were amenable without rhizotomy in the repeat oper ations. A repeat operation for failed microvascular decompression is a good choice if the condition of the patient is tolerant.