The operative findings in re-do microvascular decompression for recurrent trigeminal neuralgia

Re-do microvascular decompression (MVD) of the trigeminal nerve occasionally becomes necessary following recurrence of symptoms after a previous MVD. The indications include failure or contraindication of less invasive treatment options such as medication or trigeminal nerve lesioning and when supported by vascular compression on brain MRI scans.

To report on our findings following re-do MVD in the National Hospital for Neurology and Neurosurgery, Queen Square London from July 1995 to July 2008.

Case note review of all patients who underwent re-do MVD for the above reasons in the senior author's series in the above institution and stated period. The parameters of study interest were pre-operative MRI features, operative findings, and complete pain-free period with regards to the first and re-do MVD.

Data analysis showed that 6 underwent a re-do MVD. Neurovascular conflict was confirmed in 5 cases (83.3%) involving the superior cerebellar artery and anterior inferior cerebellar artery in 2 cases each (33.3%) and ectatic basilar artery in 1 case (16.6%). Arachnoid adhesions around the previous teflon felt were also found in 5 cases (83.3%) mostly in association with other findings. Neo-arachnoid cyst formation in the corresponding cerebello-pontine angle, was an unexpected finding in 2 cases (33.3%), though of uncertain significance.

Redo MVD should be considered as a safe and effective treatment option in recurrent trigeminal neuralgia, which fails to respond to non-surgical means.