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Findings and long-term results of subsequent operations after failed microvascular decompression for trigeminal
S A Rath1, H J Klein, H P Richter
1Department of Neurosurgery, University of Ulm, Günzburg, Germany.
Objective:
To evaluate the indication of subsequent operations after failed microvascular decompression (MVD) for the treatment of trigeminal neuralgia, the intraoperative findings and long-term results of 16 subsequent operations are reported.
Methods:
Subsequent exploration of the posterior fossa was performed for lack of pain relief (3 patients) and recurrent neuralgia (13 patients) after an average of 17 months (range, 4-62 mo). In all patients, typical arterial compression patterns at the root entry zone of the trigeminal nerve were found in the first procedure. The mean follow-up period after subsequent operation was 90 months (range, 78-104 mo).
Results:
New arterial neurovascular conflicts were found in nine patients. After subsequent MVD procedures, seven patients were pain-free (with one recurrence after 6 mo), one had constant marked relief, and one was unchanged. Second exploration revealed no abnormalities in the other seven patients who experienced continued or recurrent pain; only careful neurolysis of the trigeminal nerve was performed in those patients. Initially, all seven patients obtained complete pain relief, but two experienced late recurrences after 64 and 68 months, respectively. Thus, subsequent operations failed in all 4 patients who had undergone prior destructive procedures but were successful in those 12 patients who had undergone only previous MVD. Two patients developed severe sequelae, and the other nine had minor complications, especially permanent (four patients) or transitory (three patients) ipsilateral trigeminal hypoesthesia.
Conclusion:
Subsequent MVD seems to have good long-term results. However, because of the significantly high incidence of complications, the indication for subsequent operations should be restricted to younger patients to avoid destructive procedures. In general, glycerol rhizolysis or radiofrequency rhizotomy may be the treatment of choice after failed MVD.
Insights
Subsequent microvascular decompression (MVD) for trigeminal neuralgia shows good long-term results, especially in younger patients. However, complications are common, suggesting glycerol rhizolysis or radiofrequency rhizotomy may be preferred after initial MVD failure.
Area of Science:
- Neurosurgery
- Neurology
Background:
- Trigeminal neuralgia (TN) is a debilitating neuropathic pain condition.
- Microvascular decompression (MVD) is a primary surgical treatment for TN.
- Failed MVD necessitates evaluation of subsequent treatment options.
Purpose of the Study:
- To assess the efficacy and outcomes of repeat MVD surgeries for trigeminal neuralgia.
- To analyze intraoperative findings and long-term results of subsequent MVD procedures.
- To determine the indications and risks associated with repeat MVD in TN patients.
Main Methods:
- Retrospective analysis of 16 patients undergoing subsequent posterior fossa exploration after initial MVD.
- Evaluation of pain relief, recurrence rates, and complications.
- Comparison of outcomes between patients with prior MVD only versus those with prior destructive procedures.
Main Results:
- Subsequent MVD provided pain relief in most patients, particularly those with identified new neurovascular conflicts.
- Success rates were higher in patients with no prior destructive procedures.
- Complications included trigeminal hypoesthesia, with a significant incidence of sequelae in some cases.
Conclusions:
- Repeat MVD can yield good long-term pain relief for trigeminal neuralgia.
- Patient selection, especially age, is crucial due to complication risks.
- Alternative treatments like glycerol rhizolysis or radiofrequency rhizotomy may be considered after failed MVD.