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ObjectiveTo prospectively compare facial pain outcomes for patients having either a repeat microvascular decompression (MVD) or percutaneous balloon compression (PBC) as their surgery for trigeminal neuralgia (TN) recurrence. MethodsProspective cohort study of 110 patients with TN recurrence who had either redo MVD (n=68) or PBC (n=42) from July 2010 until September 2016. The mean follow-up was 45.6 months. ResultsAfter redo MVD, 65 patients (95.6%) experienced immediate relief of pain. After PBC, 34 patients (81%) were immediately relieved of their neuralgia. After 1 month, the clinical effect of redo MVD was better than PBC (p<0.01). Patients who had redo MVD more commonly were pain free off medications (93.4% at 1 year, 78.2% at 4 years) compared with the PBC patients (85.1% at 1 year, 59.3% at 4 years). However, mean length of stay was longer (p>0.05). Patients after PBC who occurred developed herpes simplex (35.7%), facial numbness (76.2%), and annoying dysesthesia (21.4%) more frequently compared with patients after redo MVD who occurred developed herpes simplex (14.7%), facial numbness (8.8%), and hypoesthesia (5.9%) (p<0.05). The symptoms recurred respectively in 15 patients (22.1%) and 19 patients (45.2%) after redo MVD and PBC within the entire 6-year follow-up period. ConclusionFor the patients with TN recurrence, redo MVD was a more effective procedure than PBC. The cure rate and immediate relief of pain were better, and the incidence of complications was lower.

Persistent proatlantal artery is one rare kind of persistent primitive anastomoses between carotid and basilar vascular system. This case firstly introduces a type I proatlantal artery with complex vascular anomalies of bilateral vertebral arteries and a ruptured aneurysm, which is extremely uncommon. A 43-year-old female was hospitalised for SAH and ventricular hematocele. The subsequent digital subtraction angiography and computed tomography angiography revealed a type I proatlantal artery which arises from left internal carotid artery, associating with a hypoplastic right vertebral artery, an aplastic left vertebral artery and a ruptured left posterior inferior cerebellar artery aneurysm. An interventional procedure was taken later. The present case raises awareness on the incidence of persistent primitive anastomoses which combined other complex vascular anomalies before surgical or interventional procedures, especially in view of unique blood supply to posterior circulation from the primitive vessel.