Repeat microvascular decompression for recurrent idiopathic trigeminal neuralgia

Bakker, Nicolaas A.; Dijk, J. Marc C. van; Immenga, Steven; Wagemakers, Michiel; Metzemaekers, Jan D. M.

doi:10.3171/2014.7.jns132667

Cited by 41 publications

(37 citation statements)

References 10 publications

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“…In the current study, there was no statistical association between various factors and surgical outcomes. However, this discrepancy may indicate a difference in our study population, as Bakker et al3) only investigated patients who underwent MVD alone.…”

Section: Discussionmentioning

confidence: 90%

“…Although the success rate of re-operation falls between 51% and 93.3% (Table 4)236112023303139), the success rate of percutaneous procedures is up to 57%12). The performance of a PSR procedure with or without MVD can be considered as an option for repeat operative intervention.…”

Section: Discussionmentioning

confidence: 99%

“…Several authors have compiled there currence rates for each of the surgical and non-surgical procedures currently available (MVD, 30%; SRS, 43%, GR, 68–78%; BC, 45%; and RFR, 42%)47222632). Repeat surgical treatments (including MVD) have been reported to be reasonable options for recurrent TN, even after neurodestructive procedures; however, this approach has lower success rates and higher complication rates than primary surgery31432). We reviewed our experiences in the surgical treatment of TN patients with persistent or recurrent pain despite prior treatment.…”

Section: Introductionmentioning

confidence: 99%

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A Clinical Analysis of Secondary Surgery in Trigeminal Neuralgia Patients Who Failed Prior Treatment

Kang

Park

et al. 2016

J Korean Neurosurg Soc

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ObjectiveAlthough many treatment modalities have been introduced for trigeminal neuralgia (TN), the long-term clinical results remain unsatisfactory. It has been particularly challenging to determine an appropriate treatment strategy for patients who have responded poorly to initial therapies. We analyzed the surgical outcomes in TN patients who failed prior treatments.MethodsWe performed a retrospective analysis of 37 patients with recurrent or persistent TN symptoms who underwent surgery at our hospital between January 2010 and December 2014. Patients with follow-up data of at least one year were included. The prior treatment modalities of the 37 patients included microvascular decompression (MVD), gamma knife radiosurgery (GKRS), and percutaneous procedures such as radiofrequency rhizotomy (RFR), balloon compression, and glycerol rhizotomy (GR). The mean follow-up period was 69.9 months (range : 16–173). The mean interval between the prior treatment and second surgery was 26 months (range : 7–123). We evaluated the surgical outcomes using the Barrow Neurological Institute (BNI) pain intensity scale.ResultsAmong the 37 recurrent or persistent TN patients, 22 underwent MVD with partial sensory rhizotomy (PSR), 8 received MVD alone, and 7 had PSR alone. Monitoring of the surgical treatment outcomes via the BNI pain intensity scale revealed 8 (21.6%) patients with a score of I, 13 (35.1%) scoring II, 13 (35.1%) scoring III, and 3 (8.2%) scoring IV at the end of the follow-up period. Overall, 91.8% of patients had good surgical outcomes. With regard to postoperative complications, 1 patient had transient cerebrospinal fluid rhinorrhea (2.7%), another had a subdural hematoma (2.7%), and facial sensory changes were noted in 8 (21.1%) patients after surgery.ConclusionSurgical interventions, such as MVD and PSR, are safe and very effective treatment modalities in TN patients who failed initial or prior treatments. We presume that the combination of MVD with PSR enabled us to obtain good short- and long-term surgical outcomes. Therefore, aggressive surgical treatment should be considered in patients with recurrent TN despite failure of various treatment modalities.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Clinical Analysis of Secondary Surgery in Trigeminal Neuralgia Patients Who Failed Prior Treatment

Kang

Park

et al. 2016

J Korean Neurosurg Soc

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“…However, TN recurs slightly more frequently than does hemifacial spasm. 4,12, 21,22 The reasons for recurrence or partial pain remission of TN are variable. Factors, such as Teflon granuloma formation and venous compression, have commonly been involved in the redevelopment of symptoms.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Trigeminal Neuralgia with “Microvascular Decompression Plus” Technique

Liu

Zhong

Xia

et al. 2020

J Neurol Surg B Skull Base

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Objectives Although microvascular decompression (MVD) has been widely accepted as an effective treatment of trigeminal neuralgia (TN), some patients have not been cured. To improve the postoperative outcome, the surgical procedure should be further refined. Design This is a retrospective study. Setting Present study conducted at a cranial nerve disorder center. Participants: Clinical data were collected from patients with TN who had undergone surgery in our center, including 685 who had undergone traditional MVD and 576 who had undergone the “MVD plus” procedure, in which any vessel attached to the trigeminal nerve was freed away (“nerve-combing”), which was followed by intraoperative neurolysis. Main Outcome Measures Postoperative outcomes and complications in the two groups were compared. Results Among patients who underwent traditional MVD, the rates of immediate relief and 1-year relief were 89.9 and 86.9%, respectively; among patients who underwent MVD plus group, these rates were 95.1 and 94.6%, respectively (p = 0.05). Patients who underwent MVD plus initially exhibited a higher rate of facial numbness (p < 0.05), but this finding decreased over time and reached the same level as that in the traditional MVD group within 3 months (p > 0.05). Conclusion Sufficient MVD with nerve-combing for the treatment of TN may produce a high rate of cure with less recurrence.

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“…Only a few studies have examined the outcome of MVD plus LNS or LNS only. Percutaneous balloon compression, gamma knife surgery, and repeated MVD have previously been reported to treat patients with recurrent TN, but the results were not very satisfactory (2,11,16,31 Two possible explanations for the effectiveness of this surgical method were analyzed. One explanation is that the vascular contact was dissected at the REZ of the third cranial nerve (28,31).…”

Section: █ Discussionmentioning

confidence: 99%

Effects of microvascular decompression plus longitudinal nerve sectioning on recurrent trigeminal neuralgia and investigations of postoperative recurrence causes

Luo

Cheng²,

Guo³

et al. 2018

Turkish Neurosurgery

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AIM:To investigate the causes of recurrent trigeminal neuralgia (RTN) and to evaluate the efficacy of microvascular decompression (MVD) plus longitudinal nerve sectioning (LNS) or LNS only for RTN patients who have undergone multiple procedures. MATERIAL and METHODS:Twenty one patients underwent MVD plus LNS or LNS only at our institute from June 2008 to December 2014. The patients were retrospectively reviewed and analyzed. The following data were collected: age, sex , treatment before surgery, pain severity and distribution, findings during surgery, immediate postoperative BNI (Barrow Neurological Institute score system), final follow-up BNI, complications and associated comorbidities. RESULTS:Vascular compression, arachnoid adhesion and Teflon granulomas were the primary causes of RTN. After MVD plus LNS or LNS only treatments, almost all patients (19/21, 90.5%) reported pain relief after 36.1 months. Of these patients, 15 patients (71.4%) reported being pain-free (BNI score I) and 4 patients (19.1%) reported pain relief (BNI II-III). Two patients reported a pain level of BNI IV. However, almost all patients were left with some degree of numbness. CONCLUSION:This study certified that vascular compression, arachnoid adhesion and Teflon granulomas were the reasons for RTN. MVD plus LNS or LNS only were both feasible therapeutic options, with good probabilities of success, especially after multiple neurodestructive procedures.

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Repeat microvascular decompression for recurrent idiopathic trigeminal neuralgia

Cited by 41 publications

References 10 publications

A Clinical Analysis of Secondary Surgery in Trigeminal Neuralgia Patients Who Failed Prior Treatment

A Clinical Analysis of Secondary Surgery in Trigeminal Neuralgia Patients Who Failed Prior Treatment

Treatment of Trigeminal Neuralgia with “Microvascular Decompression Plus” Technique

Effects of microvascular decompression plus longitudinal nerve sectioning on recurrent trigeminal neuralgia and investigations of postoperative recurrence causes

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