Abstract
BACKGROUNDMicrovascular decompression (MVD) is an effective non-destructive neurosurgical procedure for trigeminal neuralgia (TN). However, some patients may undergo surgery failure or experience pain recurrence, sparking debates on the need for reoperation. METHODSWe conducted a retrospective analysis of 103 cases of patients with primary TN who underwent re-do 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. RESULTSDuring the redo MVD cases, adhesions of arachnoid membranes (80.6%) and Teflon 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 paraesthesia, one case each of hearing loss, cerebrospinal fluid leak and facial palsy. Ten cases without evident compression received nerve combing (NC) and all experienced immediate complete relief, with only one 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 two 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. CONCLUSIONThe redo MVD for TN is equally efficacious and safe compared to the primary procedure, with an emphasis on meticulous dissection and thorough decompression. Additionally, NC proves to be an effective supplementary option for patients without obvious compression.
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