Reactivation of Herpes Simplex Virus after Decompression of the Trigeminal Nerve Root

Abstract

Reactivation of herpes simplex virus was prospectively studied in patients after microneurosurgical decompression of the trigeminal sensory root, a new operation for trigeminal neuralgia in which the nerve is not sectioned. Reactivation was detected in 28 (50%) of 56 patients. Virus was cultured from oropharyngeal secretions in 25 patients, and 21 patients developed cutaneous herpetic lesions. Seven patients had positive throat-wash (TW) cultures but did not develop lesions, and the converse occurred in three patients. Eighteen patients had both positive TW cultures and herpetic lesions. In eight of nine instances in which a sequence was determinable, TW cultures were positive before lesions developed. A history of recurrent herpes labialis was associated with a higher risk of developing reactivation postoperatively (59.4% vs. 31.6%, P less than 0.05). These observations suggest that minimal stimulation or inapparent trauma to the trigeminal sensory root is sufficient to activate latent herpes simplex virus in humans. These patients provide unique opportunities to study immunologic responses and therapeutic measures.

Acyclovir prophylaxis for herpes simplex virus infection

“…Dermabrasion of the face is a predictable trigger of orolabial HSV in seropositive patients, and, when reactivated, the HSV may spread to abraded areas, resulting in delayed healing and scarring. Similarly, surgeries involving the trigeminal ganglion or lumbar disks may reactivate HSV (23,41). Although HSV recurrences resulting from these procedures may not be medically serious, they pose an inconvenience, a potential source of nosocomial infection, and an additional source of pain in the postoperative period that might be prevented by a short perioperative course of ACV.…”

The pathogenesis of acute, latent and recurrent herpes simplex virus infections

“…Asymptomatic shedding of HSV can also be induced by iontophoresis of epinephrine into the cornea of rabbits with latent, HSV infections (60). HSV can be isolated from the skin of the footpad of guinea pigs (99) and the skin of the ear of mice (35) In humans asymptomatie virus shedding (but also development of recurrent lesions) is observed after microneurosurgical decompression of the trigeminal ganglion nerve root (84). Reactivation of HSV occurs commonly in immunosuppressed patients after organ transplantation (2,54,67,74,81,85,90).…”

Surgical treatment of primary trigeminal neuralgia: comparison of the effectiveness between mvd and mvd+psr in a series of 210 patients

“…HSV reactivation was reported in 27 to 94% of patients who underwent procedures mentioned above (4,15,18,19,26), which was a common complication, occurred in 49 patients (23.3%) in our series, 35 in MVD and 14 in MVD+ PSR group, respectively. Interestingly, we noticed one patient in our series, he was still in pain after operation, and then ache disappeared 6 days later, just at the same time when labial herpes occurred.…”