Revisiting the Efficacy of Redo Microvascular Decompression for Trigeminal Neuralgia

• Published in: World neurosurgery 2024-06, Vol.186, p.e335-e341
• Main Authors: Zhang, Zhongding, Zhao, Hua, Tang, Yinda, Wang, Baimiao, Yuan, Qing, Zhang, Ying, Li, Yihua, Zhong, Jun, Li, Shiting
• Format: Article
• Language: English
• Subjects: Microvascular decompression; Nerve combing; Reoperation; Trigeminal neuralgia
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2024.03.131

Microvascular decompression (MVD) is an effective nondestructive neurosurgical procedure for trigeminal neuralgia (TN). However, some patients may undergo surgery failure or experience pain recurrence, sparking debates on the need for reoperation. We conducted a retrospective analysis of 103 cases of patients with primary TN who underwent redo MVD at our center between January 2020 and December 2022. Comparative prognostic assessments were performed by comparing these cases against a cohort of 348 patients who underwent primary MVD during the same study period. During the redo MVD cases, arachnoid membranes adhesions (80.6%) and Teflon adhesions with/without granuloma (86.4%) as well as remaining vascular compression (36.9%) were observed. After the reoperation, an immediate relief rate of 94.2% was observed. During a mean follow-up period of 17.4 ± 4.4 months, a long-term relief rate of 89.3% was achieved. Postoperative complications included 3 cases of persistent paresthesia, 1 case each of hearing loss, cerebrospinal fluid leak, and facial palsy. Ten cases without evident compression received nerve combing and all experienced immediate complete relief, with only 1 patient experiencing recurrence 9 months after surgery. Compared to the primary MVD group, the reoperation group had a higher average age, longer disease duration, and operating time (P < 0.05). However, there were no significant differences in immediate relief rate, long-term relief rate, or complications between the 2 groups. The main cause of persistent symptom was inadequate decompression, such as missing the offending vessel; while the recurrent was primarily due to Teflon adhesion or granuloma formation. The redo MVD for TN is equally efficacious and safe compared to the primary procedure, with an emphasis on meticulous dissection and thorough decompression. Additionally, nerve combing proves to be an effective supplementary option for patients without obvious compression.