Abstract
Objective: To explore the clinical characteristics of patients with recurrent trigeminal neuralgia (TN) and the experience of microvascular decompression (MVD) in the treatment of such patients.Methods: We retrospectively analyzed clinical data, imaging examination results, surgical methods, and treatment efficacies in 127 patients with recurrent typical TN from January 2005 to December 2014.Results: The age of the recurrent group was higher than that of the non-recurrent group (p < 0.05). The duration of pain before the first MVD procedure was longer in the recurrent group than in the non-recurrent group (p < 0.05). Patients in the recurrent group were more likely to have compression of the trigeminal nerve by the vertebrobasilar artery (VBA) or multiple vessels than patients in the non-recurrent group (p < 0.05). A Kaplan–Meier curve showed a median pain-free survival of 12 months after the first MVD procedure. The severity of pain (preoperative visual analog scale [VAS] score) in patients with recurrence was lower than that in patients with first-onset TN (p < 0.05). Vessel compression, Teflon compression or granuloma and arachnoid adhesion were considered the main causes of recurrence. Postoperative Barrow Neurological Institute (BNI) scores in the redo MVD group were excellent (T = 2) for 69 patients (53.33%) and good (T = 3) for 46 patients (36.22%). The postoperative follow-up was 63–167 months (105.92 ± 25.66). During the follow-up, no recurrence was noted. All complications were cured or improved.Conclusions: Microvascular decompression (MVD) is an effective surgical method for the treatment of TN. For recurrent patients, reoperation can achieve good results.
Highlights
Trigeminal neuralgia (TN) is a type of paroxysmal, brief, intense pain that occurs repeatedly in the trigeminal nerve region and is divided into two types: typical and atypical
The duration of pain before the first microvascular decompression (MVD) procedure was longer in the recurrent group than in the non-recurrent group (p < 0.05)
According to the classification and diagnostic grading of TN issued by the International Association for the Study of Pain (IASP), TN is distinguished into three diagnostic categories: typical and atypical [8]
Summary
Trigeminal neuralgia (TN) is a type of paroxysmal, brief, intense pain that occurs repeatedly in the trigeminal nerve region and is divided into two types: typical and atypical. Typical TN is mostly caused by neurovascular conflict (NVC) of the trigeminal nerve [1]. The treatment of typical TN by microvascular decompression (MVD) is based on NVC. Janetta started performing MVD in the 1960s, which is recognized as the only treatment that can eliminate the cause [2]. The clinical treatment of TN with MVD surgery has a cure rate of 80–98%, but the follow-up recurrence rate is 10–30% [3]. The purpose of this study was to explore the clinical characteristics of patients with recurrent TN and the experience of MVD in the treatment of such patients to accumulate additional clinical evidence for optimal treatment protocols
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