Redo surgery for trigeminal neuralgia: reasons for re-exploration and long-term outcomes

Inoue, Tan; Shitara, Satoshi; Goto, Yukihiro; Prasetya, Mustaqim; Radcliffe, Lori; Fukushima, Takanori

doi:10.1007/s00701-021-04920-1

Cited by 5 publications

(4 citation statements)

References 24 publications

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“…It is quite possible that a high proportion of patients who were described to have unspecific findings upon reexploration for recurrent TN in early studies had findings as described above or others which were not considered to be possibly causative [18]. Other findings to be considered are distortion or indentation of the trigeminal nerve root [17,35], which was also noted in our series.…”

Section: Discussionmentioning

confidence: 50%

“…Few studies have been aimed at identifying the risk factors and pathophysiological mechanisms leading to recurrence [1, 2, 9-11, 21, 41, 46, 48]. Possible causes for recurrence might include new vascular contact, scarring/adhesions, and Teflon granuloma, but in some patients, no definitive cause has been ascribed [5,9,17,18,39,43]. It is unclear which therapeutic options may be offered to a patient with recurrent TN-either after previous MVD or after ablative surgery.…”

Section: Introductionmentioning

confidence: 99%

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Microsurgical posterior fossa re-exploration for recurrent trigeminal neuralgia after previous microvascular decompression: common grounds—scarring, deformation, and the “piston effect”

Hatipoglu Majernik,

Wolff Fernandes,

Al-Afif

et al. 2023

Acta Neurochir

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Objective Microvascular decompression (MVD) is a well-accepted treatment modality for trigeminal neuralgia (TN) with high initial success rates. The causes for recurrence of TN after previously successful MVD have not been fully clarified, and its treatment is still a matter of debate. Here, we present the surgical findings and the clinical outcome of patients with recurrent TN after MVD who underwent posterior fossa re-exploration. Methods Microsurgical posterior fossa re-exploration was performed in 26 patients with recurrent TN (mean age 59.1 years) who underwent MVD over a period of 10 years. The trigeminal nerve was exposed, and possible factors for recurrent TN were identified. Arachnoid scars and Teflon granulomas were dissected meticulously without manipulating the trigeminal nerve. Outcome of posterior fossa re-exploration was graded according to the Barrow Neurological Institute (BNI) pain intensity score. Follow-up was analyzed postoperatively at 3, 12, and 24 months and at the latest available time point for long-term outcome. Results The mean duration of recurrent TN after the first MVD was 20 months. Pain relief was achieved in all patients with recurrent TN on the first postoperative day. Intraoperative findings were as follows: arachnoid scar tissue in 22/26 (84.6%) patients, arterial compression in 1/26 (3.8%), venous contact in 8/26 (30.8%), Teflon granuloma in 14/26 (53.8%), compression by an electrode in Meckel’s cave used for treatment of neuropathic pain in 1/26 (3.8%), evidence of pulsations transmitted to the trigeminal nerve through the Teflon inserted previously/scar tissue (“piston effect”) in 15/26 (57.7%), and combination of findings in 18/26 (69.2%). At long-term follow-up (mean 79.5 months; range, 29–184 months), 21/26 (80.8%) patients had favorable outcome (BNI I-IIIa). New hypaesthesia secondary to microsurgical posterior fossa re-exploration occurred in 5/26 (19.2%) patients. Conclusions Posterior fossa re-exploration avoiding manipulation to the trigeminal nerve, such as pinching or combing, may be a useful treatment option for recurrent TN after previously successful MVD providing pain relief in the majority of patients with a low rate of new hypaesthesia.

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Section: Discussionmentioning

confidence: 50%

Section: Introductionmentioning

confidence: 99%

Microsurgical posterior fossa re-exploration for recurrent trigeminal neuralgia after previous microvascular decompression: common grounds—scarring, deformation, and the “piston effect”

Hatipoglu Majernik,

Wolff Fernandes,

Al-Afif

et al. 2023

Acta Neurochir

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“…Sindou et al demonstrated the importance of a non-compressive MVD technique to avoid recurrence in a large TN cohort ( 11 ). It is crucial that a Teflon felt should be placed away from the nerve root to avoid future adhesion and granulation formation ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

Case report: Teflon granuloma following microvascular decompression manifesting as light-triggered trigeminal neuralgia

et al. 2022

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Trigeminal Neuralgia is commonly triggered by stimuli in the area of the trigeminal nerve innervation. We report an exceptionally rare case of a 61-year-old woman who complained of recurrent trigeminal neuralgia, which sole trigger was seeing a bright light. Teflon felt that was placed on the nerve root in the initial surgery was suspected of causing this rare type of trigeminal neuralgia. A reflex circuit linking luminance to trigeminal nerve activity may be implicated in activating a trigeminal nociceptive pathway by a bright light trigger.

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“…Data on the preferred treatment of patients with recurrent TN are limited. Fossa posterior re-exploration (redo MVD) is an effective treatment measure for recurrent TN after failed MVD ( 39 , 42 , 43 ); however, studies have found that re-MVD is more effective in patients with residual responsible vessels ( 44 , 45 ). If no vascular compression is found during re-exploration, partial sensory rhizotomy, internal neurolysis, or trigeminal nerve combing can be used ( 40 , 42 ).…”

Section: Recurrence and Complicationsmentioning

confidence: 99%

Microvascular decompression: Diversified of imaging uses, advantages of treating trigeminal neuralgia and improvement after the application of endoscopic technology

Leng²,

Xia³

et al. 2022

Front. Neurol.

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Classical trigeminal neuralgia (CTN) is a unilateral and severe facial pain disease, which seriously affects the patient's quality of life. Microvascular decompression (MVD) is currently the most effective surgical method, and it is the only treatment for the etiology of CTN. Imaging for MVD has been increasingly used, and the advantages and disadvantages of endoscopy-assisted vascular decompression surgery have been controversially debated. In this review, we aimed to discuss the advantages of MVD in the treatment of patients with CTN, the importance of using imaging in disease management, and the improvements of vascular decompression surgery through the application and maturity of endoscopic techniques. Compared with other surgical methods, MVD has more prominent short- and long-term treatment effects. Its selection depends on the accurate discovery of neurovascular compression by preoperative imaging. Moreover, magnetic resonance imaging plays a diverse role in MVD, not only in identifying the responsible vessels but also in determining the prognosis and as a tool for scientific research. The use of endoscopic techniques provides improved visualization of the MVD and additional benefits for vascular decompression surgery.

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Redo surgery for trigeminal neuralgia: reasons for re-exploration and long-term outcomes

Cited by 5 publications

References 24 publications

Microsurgical posterior fossa re-exploration for recurrent trigeminal neuralgia after previous microvascular decompression: common grounds—scarring, deformation, and the “piston effect”

Microsurgical posterior fossa re-exploration for recurrent trigeminal neuralgia after previous microvascular decompression: common grounds—scarring, deformation, and the “piston effect”

Case report: Teflon granuloma following microvascular decompression manifesting as light-triggered trigeminal neuralgia

Microvascular decompression: Diversified of imaging uses, advantages of treating trigeminal neuralgia and improvement after the application of endoscopic technology

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