Repeat Microvascular Decompression for Recurrent Trigeminal Neuralgia

To review our experience with patients presenting with recurrent trigeminal neuralgia (TN) and who have undergone repeat microvascular decompression surgery (rMVD).

This retrospective observational study was conducted at the Department of Neurosurgery at a university hospital. Patients who initially experienced complete pain relief after the first MVD but later had a recurrence of TN symptoms which required an rMVD were included in the study. Pain control outcomes were evaluated based on the Barrow Neurological Institute (BNI) scale score.

Of the 375 patients who underwent MVD for TN over a 20-year period, 19 patients (6 females and 13 males) with a mean age of 57.68 ± 9.78 years developed symptom recurrence which necessitated an rMVD (5.06%). The average duration of the symptoms before the rMVD was 16.1 ± 19.36 months. The mean BNI score of the patients before the rMVD was 4.5 ± 0.5. Recurrence was primarily attributed to compression by a new offending vessel (n=9, 47.4%) or a Teflon granuloma (n=8, 42.1%). Two patients (10.5%) did not have any identifiable compression. During a follow-up period of 106.3 ± 58.3 months, excellent pain relief (BNI-I) was achieved in 10 patients (52.6%). Eight patients (42.1%) experienced a good outcome (BNI-III), and one patient (5.3%) experienced a poor outcome (BNI-IV).

Recurrence of TN symptoms can occur even after an initially successful MVD. Subsequent MVDs should be considered as the primary treatment option for recurrent TN, as it significantly controls pain with low morbidity.