Redo Microvascular Decompression Research Articles

Very early re-do microvascular decompression for patients with trigeminal neuralgia

Although microvascular decompression (MVD) is the widely recognized surgical option for patient with trigeminal neuralgia (TN), and most patients could receive satisfactory outcome, some patients still complained of severe pain, with culprit vessel omission and incomplete decompression as the commonly mentioned reasons. Here we reported three cases of very early re-do MVD for patients with TN. We found that both artery and vein simultaneous compressed the trigeminal nerve, and tight adhesion was found between the vein and nerve. The artery was totally decompressed, but the vein could not be decompressed without affecting the blood flow due to the severe adhesion, the patients still complained of severe pain after the first surgery. Very early re-do MVD was performed and we totally separated the veins from the nerve. The symptoms of patients disappeared immediately without any complication. No recurrence was found during follow up. We conclude that culprit vein should be retained if possible, rather than sacrificed, and very early reoperation may be a feasible choice for patient with persistent symptom after MVD.

Teflon Granuloma: A Common Cause of Recurrent Trigeminal Neuralgia

Trigeminal neuralgia (TN) is a common pain syndrome of the nervous system,. Although about 90% patients who were refractory to medications could be free from pain after microvascular decompression (MVD), some patients did experience recurrence. The study aimed to analyze clinical characteristics of patients with recurrent TN, recurrence factors of TN, and prognosis after re-do MVD. Clinical data and at least 12 months follow-up of patients with recurrent TN who underwent re-do MVD in our hospital from 2005 to 2020 were collected and analyzed. A total of 14 patients with recurrent TN were enrolled eventually; adhesive arachnoid membranes were found in all patients. Teflon granuloma was found in 10 patients, new neurovascular compression (NVC) in 3 patients, and vascular displacement in 1 patient. Pain disappeared in 12 patients and relieved in 2 patients, but 4 patients experienced mild facial numbness and 1 patient suffered from incision infection after re-do MVC. No serious surgery-related complications and pain recurrences were recorded. Teflon granuloma was the most common cause of TN recurrence in current study, new NVC was also saw in some patients. Patients with recurrent TN could get satisfactory results from re-do MVD.

Simultaneous Endoscopic and Microscopic Visualization in Microvascular Decompression for Hemifacial Spasm.

Hemifacial spasm (HFS) is a socially limiting condition leading to decreased quality of life that can be treated with microvascular decompression (MVD). Endoscopy has been described as an adjunct to traditional microscopy for MVD, although the best visualization technique is debated. To review the current literature on use of endoscopy in MVD for HFS and to describe the simultaneous microscopic and endoscopic visualization technique along with a video illustration. Patients who underwent MVD for HFS were retrospectively reviewed from January 2011 to December 2019. The first set of patients in the series were done using traditional endoscopic assisted visualization, followed by a change in technique in the subsequent patients using the simultaneous endoscopic technique. The surgical technique is described as well as illustrated with a video. In total, 21 patients underwent 24 MVDs to treat HFS. The simultaneous endoscopic/microscopic technique was used in 48% of cases for visualization. All but one patient had resolution of their symptoms immediately after the procedure. In total, 7 patients had recurrence of HFS, with 4 (17%) resolving spontaneously and 3 (13%) ultimately undergoing redo MVD. Postoperatively 7 patients (29%) had transient complications that all resolved completely. There was no significant difference between the traditional alternating microscopic and endoscopic technique with the simultaneous endoscopic microscopic technique. Endoscopic assistance during MVD for HFS is beneficial and may be streamlined by using the simultaneous microscope and endoscope visualization technique.

Long-Term Retrospective Analysis of Re-do Microvascular Decompression in Patients With Hemifacial Spasm.

Objective: To explore the clinical characteristics of patients with persistent or recurrent hemifacial spasm (HFS) and the experience of microvascular decompression (MVD) in the treatment of such patients to accumulate additional clinical evidence for optimal treatment protocols.Methods: We retrospectively analyzed the clinical data, surgical methods and treatment efficacies of 176 patients with persistent or recurrent HFS from January 2009 to January 2018.Results: Missing compression zones was the main reason for symptom persistence (87.50%) or recurrence (71.50%) after MVD treatment of HFS. We divided the surgical area into three zones. Most persistent or recurrent cases had decompression only in the root exit zone (REZ) (Zone 1) but missed the ventrolateral pons-involved area (Zone 2) or the bulbopontine sulcus-involved area (Zone 3) in the first MVD. Too much use of Teflon (12.50%), arachnoid adhesions (5.60%) and Teflon granulomas (10.40%) can also cause a recurrence. The difference between preoperative and postoperative Cohen scores was statistically significant in persistent or recurrent HFS patients (p<0.05). The postoperative follow-up time ranged from 36 to 108 months (71.75 ± 22.77).Conclusions: MVD should be performed in the compression site, which is mostly located at the brainstem/facial REZ. Intraoperative exploration should be conducted in accordance with the abovementioned zones to effectively avoid missing offending vessels. Re-do MVD is effective in patients with persistent or recurrent HFS.

Long-Term Retrospective Analysis of Microvascular Decompression in Patients With Recurrent Trigeminal Neuralgia.

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.

Spasm Freedom Following Microvascular Decompression for Hemifacial Spasm: Systematic Review and Meta-Analysis

Hemifacial spasm (HFS) is a debilitating disorder characterized by intermittent involuntary movement of muscles innervated by the facial nerve. HFS is caused by neurovascular compression along the facial nerve root exit zone and can be treated by microvascular decompression (MVD). The goal was to determine rates and predictors of spasm freedom after MVD for HFS. A literature search using the key terms "microvascular decompression" and "hemifacial spasm" was performed. The primary outcome variable was spasm freedom at last follow-up. Analysis was completed to evaluate for variables associated with spasm-free outcome. A total of 39 studies including 6249 patients were analyzed. Overall spasm freedom rate was 90.5% (5652/6249) at a follow-up of 1.25 ± 0.04 years. There was no significant relationship between spasm freedom versus persistent spasm and age at surgery, timing of follow-up, gender, disease duration, side of disease, or vessel type. Spasm freedom was more likely after an initial surgery versus a redo MVD (odds ratio 4.16, 95% confidence interval 1.99-8.68; P < 0.01). MVD works well for HFS with cure rates >90% at 1-year follow-up in 6249 patients from 39studies. A significant predictor of long-term spasm freedom at 1 year was an initial MVD as compared to repeat MVD. The majority of published manuscripts on MVD for HFS are heterogeneous single-institutional retrospective studies. As such, a large-scale meta-analysis reporting outcome rates and evaluating significant predictors of spasm freedom provides utility in the absence of randomized controlled studies.

Analysis of Failed Microvascular Decompression in Patients with Trigeminal Neuralgia.

Background Microvascular decompression (MVD) has been widely accepted as a definitive therapy for primary trigeminal neuralgia (TN). However, some patients may not experience relief of TN symptoms following surgery. In this study, the findings of redo MVD are discussed. Methods Between 2015 and 2017, 205 patients with primary TN underwent MVD surgery in Shanghai Tongren Hospital. Among these patients, 187 had immediate complete relief of symptoms, 8 improved apparently, and 10 reported no symptom relief. Of the 10 patients without relief, 6 underwent reoperation within 5 days, 2 underwent reoperation 3 months after the first procedure, and 2 refused to undergo reoperation. Results The symptoms of those patients who received reoperation disappeared immediately after the surgery. In the second operations, new conflict sites at the motor roots were found in five cases. The real offending vessels were the superior cerebellar artery (SCA) or branch of the SCA in seven cases and the petrosal vein in one case. The nerve was not decompressed completely in either of the two cases. At the 12-month follow-up, no recurrence was found. For the other two patients who did not have reoperation, their symptom persisted. Postoperative complications showed no significant differences between the first and second operations. Conclusion Compression of the motor roots might be one of the causes of TN. Thorough exploration of both sensory and motor roots of the trigeminal nerve is essential to performing a successful MVD operation. Early reoperation for resistant TN after MVD does not increase the incidence of complications.

Missed Culprits in Failed Microvascular Decompression Surgery for Hemifacial Spasm and Clinical Outcomes of Redo Surgery

To identify causes of recurrent hemifacial spasm (HFS) after initial microvascular decompression (MVD) and to assess the feasibility of redo MVD. The study included 21 patients who underwent redo MVD over the last 2 decades. Their medical charts were retrospectively reviewed for preoperative medical history, previous and redo MVD intraoperative findings, and previous and redo MVD postoperative outcomes. Redo MVDs were the second operation in 20 patients and the third operation in 1 patient. The median interval between previous and redo MVD was 46.3 months (range, 14.4-188.2 months). Compression of offending vessels such as a vein or perforating artery located medial to or at the cisternal segment of the facial nerve was found to be a possible cause of previous MVD failure. MVD failure resulted from neglect of offending vessels in 10 patients, insufficient decompression in 7 patients, and untouched neurovascular compression sites in 4 patients. Spasm-free rates after redo MVD were 80.5% at 1 year and 90.5% in the last year of follow-up (median, 15.8 months; range, 3.6-152.0 months). Permanent hearing loss and facial palsy were each observed in 2 patients (9.5%). In addition, 1 patient each experienced cerebellar infarction and vocal cord palsy. Redo MVD remains a feasible treatment option for patients with HFS who failed to benefit from previous MVD, but it is associated with an increased risk of cranial nerve and vascular injuries.

Prospective Comparison of Redo Microvascular Decompression and Percutaneous Balloon Compression as Primary Surgery for Recurrent Trigeminal Neuralgia.

ObjectiveTo prospectively compare facial pain outcomes for patients having either a repeat microvascular decompression (MVD) or percutaneous balloon compression (PBC) as their surgery for trigeminal neuralgia (TN) recurrence. MethodsProspective cohort study of 110 patients with TN recurrence who had either redo MVD (n=68) or PBC (n=42) from July 2010 until September 2016. The mean follow-up was 45.6 months. ResultsAfter redo MVD, 65 patients (95.6%) experienced immediate relief of pain. After PBC, 34 patients (81%) were immediately relieved of their neuralgia. After 1 month, the clinical effect of redo MVD was better than PBC (p<0.01). Patients who had redo MVD more commonly were pain free off medications (93.4% at 1 year, 78.2% at 4 years) compared with the PBC patients (85.1% at 1 year, 59.3% at 4 years). However, mean length of stay was longer (p>0.05). Patients after PBC who occurred developed herpes simplex (35.7%), facial numbness (76.2%), and annoying dysesthesia (21.4%) more frequently compared with patients after redo MVD who occurred developed herpes simplex (14.7%), facial numbness (8.8%), and hypoesthesia (5.9%) (p<0.05). The symptoms recurred respectively in 15 patients (22.1%) and 19 patients (45.2%) after redo MVD and PBC within the entire 6-year follow-up period. ConclusionFor the patients with TN recurrence, redo MVD was a more effective procedure than PBC. The cure rate and immediate relief of pain were better, and the incidence of complications was lower.

What Should We Do for Those Hemifacial Spasm Patients Without Efficacy Following Microvascular Decompression: Expectation of Delayed Relief or Early Reoperation?

Although microvascular decompression (MVD) has been widely accepted as an effective treatment for hemifacial spasm (HFS), some patients may experience delayed relief instead of immediate improvement after the surgery. The need for and timing of repeat MVD has been controversial to date; thus, we conducted the present study with emphasis on those unrelieved patients. Between January 2010 and December 2014, 3095 patients with idiopathic HFS were treated with MVD at XinHua Hospital, Shanghai Jiaotong University School of Medicine. Among these patients, 174 (5.6%) reported no symptom relief. Those patients without immediate relief were the focus of this study, and all were reevaluated at 2 years after MVD surgery. Among these 174 patients, 96 underwent redo MVD within 1 week of the first procedure (early MVD redo group), 19 underwent redo between 3 and 12 months after the first procedure (late MVD redo group), and 59 were observed (observation group). In the early redo MVD group, immediate improvement was reported by all patients except 1, who did not experience symptom relief until 3 months later. In the later redo MVD group, immediate symptom improvement was reported by 14 of 19 patients. By the end of the 2-year follow-up period, 1 recurrence occurred in the early redo MVD group, no changes occurred in the later MVD group, and 9 patients improved in the observation group. Ultimately, the final rates of symptom relief were 99.0% in the early redo MVD group, 73.7% in the later redo MVD group, and 15.3% in the observation group (P < 0.01). In the early redo MVD group, postoperative courses showed no significant differences between the first and the second operations. In the later redo MVD group, 1 patient developed a mild facial palsy and 1 had a cerebrospinal fluid leak. Our findings demonstrate that MVD is the most effective treatment for patients with HFS. An early reoperation is easier and safer than a later reoperation and may improve the likelihood of immediate relief.

Long-Term Efficacy of Nerve Combing for Patients with Trigeminal Neuralgia and Failed Prior Microvascular Decompression.

Microvascular decompression (MVD) of the trigeminal nerve is the most effective treatment for trigeminal neuralgia (TN). However, many patients respond poorly to initial MVD. For these patients, redo MVD is commonly done. There has been no research regarding the effectiveness of nerve combing (NC) plus MVD in patients with TN and failed prior MVD. We compared the clinical outcome of NC plus MVD and simple redo MVD in patients with TN and failed prior MVD. We performed a retrospective analysis of 148 patients with recurrent or persistent TN symptoms who underwent surgery between January 2007 and December 2015. Simple MVD was performed in 62 patients, and NC plus MVD was performed in 86 patients. For simple MVD, success rates at 1 day, 7 days, 1 month, 3 months, and 1 year after surgery all were approximately 80%. Success rates of NC plus MVD were significantly (P < 0.05) higher than success rates of simple MVD, by 17.02%, 18.64%, 16.47%, 17.21%, and 14.80% at 1 day, 7 days, 1 month, 3 months, and 1 year. The incidence rates of facial numbness in the simple MVD group were 48.39%, 45.16%, 36.67%, 16.95%, and 1.75% at 1 day, 7 days, 1 month, 3 months, and 1 year; the incidence rates in the NC plus MVD group were 60.47%, 55.81%, 48.24%, 21.69%, and 3.75% (P > 0.05). In patients with TN who failed prior MVD, NC plus MVD significantly improved the success rate of the operation compared with simple redo MVD. We obtained good short-term and long-term surgical outcomes with NC combined with MVD.

Second microvascular decompression for trigeminal neuralgia in recurrent cases after microvascular decompression.

The objectives of this work are to report the outcomes of our finding during microvascular decompression (MVD) for patients with recurrent trigeminal neuralgia (TN) and to introduce the sling retraction technique. The authors performed a retrospective review of redo MVD for consecutive cases with recurrent TN after previous operation. Sling retraction techniques were used during the reoperation. Fifteen patients underwent redo MVD. During the second operation, arachnoid adhesion of the Teflon felt was confirmed at the trigeminal nerve in 10 cases, and neurovascular conflict was found in 4 cases. Symptoms were completely relieved in 14 patients (93.3%) and partially relieved in 1 patient (6.7%). The mean follow-up period was 38 months (range, 21-60 months), and no patient experienced recurrence. Arachnoid adhesion of the Teflon felt and vascular compression to the nerve were main causes of recurrence. The sling retraction technique is still an effective and useful treatment for recurrent TN after MVD.

Delayed relief of hemifacial spasm after microvascular decompression: can it be avoided?

Although microvascular decompression (MVD) surgery has been widely accepted as an effective treatment for hemifacial spasm (HFS), delayed relief cases have been frequently reported. Therefore, the value of an immediate redo MVD should be discussed. This study included 1,435 HFS patients who underwent MVD with intraoperative abnormal muscle response (AMR) monitoring from 2011 through 2013 at XinHua Hospital. These cases were analyzed retrospectively with emphasis on the postoperative outcomes and introaperative findings. After MVD, 1,384 HFS patients obtained relief immediately. The 51 unrelieved patients underwent AMR monitoring again the next day; this was positive in 48 and negative in 3 patients. These three patients with negative AMR obtained relief spontaneously within a week. Among the 48 positive patients, 31 and 11 were underwent redo MVD within a week and 5-22 months, respectively, and all achieved relief after the second operation. Of the six remainig patients, two obtained relief within 2 months and 4 remained unchanged in the up-to-3-year's follow-up period. In redo MVDs, insufficient decompression of the facial nerve accounted for the failure. Finally, in this database, the immediate postoperative cure rate was 96.4 %; with earlier redo MVD, the final cure rate could be increased to 99.9 %. Despite being a reasonable remedy for HFS in the hands of an experienced neurosurgeon, sometimes small vessels can be missed while managing the main offending arteries during MVDs, which might account for the delayed relief. Therefore, reexamination of the AMR is necessary for unimproved patients; if a positive result is recorded, an immediate redo MVD is suggested.

Microvascular decompression for recurrent trigeminal neuralgia

Recurrence of trigeminal neuralgia (TN) symptoms after microvascular decompression (MVD) is a challenge for neurosurgeons. This study evaluates the indication, efficacy and safety of re-do MVD. We retrospectively reviewed consecutive patients who underwent MVD for TN from January 2000 to June 2012. The parameters of study interest were pre-operative magnetic resonance tomographic angiography (MRTA) findings and operative findings. Pain outcome was scored using the Barrow Neurological Institute (BNI) grading scale. Twelve patients underwent re-do MVD following recurrence of pain. Vascular compression was detected on pre-operative MRTA images in eight patients, a small mass was found in two patients, and pre-operative imaging was negative in two patients. Of the eight patients with a positive finding of arterial conflict, a vascular loop was identified intra-operatively in five patients (62.5%); in two (25.0%) a small granuloma filled with Teflon fibers was found compressed the trigeminal nerve; and in one patient (12.5%) only dense arachnoid adhesions were found around the trigeminal nerve. For the two patients with mass compression on MRTA images, a granuloma was found during operation. Neurovascular compression was found in the two patients with negative preoperative MRTA images. Re-do MVD is a safe and effective treatment for recurrent TN when indicated by a prolonged pain-free period following the first surgery.

Microvascular decompression for hemifacial spasm: focus on late reoperation

The objective of this study is to investigate late repeat microvascular decompression (MVD) with persistent or recurrent hemifacial spasm (HFS) and to compare the clinical characteristics, intraoperative findings, complications, and outcomes with first MVD. We analyzed MVDs performed at the University of Pittsburgh Medical Center between January 1, 2000 and December 31, 2007. Thirty-three patients who underwent late redo MVDs were classified as group I and 243 patients who underwent their first MVD as group II. Clinical data were collected to analyze the difference between the two groups. The mean follow-up period was 54.48 months (range, 9-102 months). There is no significant difference in preoperative clinical characteristics (gender, age, side of MVD, botox usage, facial weakness) between the two groups. In present study, we found a vein as the offending vessel in significantly more number of patients who underwent repeat MVD as compared to first MVD (P = 0.02). The lateral spread response disappeared in 66% of patients during repeat MVDs, which is not different from those undergoing their first MVD. No difference in the relief rate was found during the immediate postoperative, discharge, or follow-up stages between repeat and first MVD. Moreover, no difference was found in the incidence of complications between repeat MVD and first MVD. Late repeat MVD for HFS is an effective and safe procedure. No specific preoperative clinical characteristics were identified in patients with repeat MVD. Intraoperative monitoring with lateral spread response (LSR) is an effective tool to evaluate adequate decompression. In patients with persistent LSR at the end of the procedure, facial nerve compression from a vein should be examined. We believe that it is important to undergo a repeat MVD for failed HFS relief irrespective of the timing of the operation.

A clinical analysis on microvascular decompression surgery in a series of 3000 cases

ObjectiveDespite the microvascular decompression (MVD) has become a definitive treatment for trigeminal neuralgia (TN) and hemifacial spasm (HFS), not all of the patients have been cured completely so far and this sort of operation is still with risk because of the critical operative area. In order to refine this surgery, we investigated thousands MVDs. MethodsAmong 3000 consecutive cases of MVDs have been performed in our department, 2601 were those with typical TN or HFS, who were then enrolled in this investigation. They were retrospectively analyzed with emphasis on the correlation between surgical findings and postoperative outcomes. The differences between TN and HFS cases were compared. The strategy of each surgical process of MVD was addressed. ResultsPostoperatively, the pain free or spasm cease occurred immediately in 88.3%. The symptoms improved at some degree in 7.2%. The symptoms unimproved at all in 4.5%. Most of those with poor outcome underwent a redo MVD in the following days. Eventually, their symptoms were then improved in 98.7% of the reoperative patients. The majority reason of the failed surgery was that the neurovascular conflict located beyond REZ or the offending veins were missed for TN, while the exact offending artery (arteriole) was missed for HFS as it located far more medially than expected. ConclusionA prompt recognition of the conflict site leads to a successful MVD. To facilitate the approach, the craniotomy should be lateral enough to the sigmoid sinus. The whole intracranial nerve root should be examined and veins or arterioles should not be ignored. For TN, all the vessels contacting the nerve should be detached. For HFS, the exposure should be medial enough to the pontomedullary sulcus.

An analysis of failed microvascular decompression in patients with hemifacial spasm: focused on the early reoperative findings

Although the microvascular decompression (MVD) has become a definitive treatment for the primary hemifacial spasm (HFS), there still are some failed cases. To obtain a satisfactory postoperative outcome, those failure cases of MVD need to be analyzed. Between January and October 2009, 393 patients with primary HFS underwent MVD. Postoperatively, 375 presented complete spasm-free, 7 improved apparently, and 11 without any improvement at all. A reoperation was performed in 9 of the 11 patients who had poor outcome within 5 days. Those redo MVD cases were reviewed. After the reoperation, the symptom of those patients all disappeared immediately. Therefore, the final outcomes were excellent in 97.7%, good in 1.8%, and poor in 0.5%. Up to the 1 year follow-up period, neither recurrence nor change was found. For the two patients without reoperation, their symptoms remained. The previous surgery was a failure due to insufficient decompression in two and conflict missed in seven. A successful MVD operation is attributable to a thorough exploration of the entire nerve course. An early relief should become the ambition of the operator while performing MVD.

The operative findings in re-do microvascular decompression for recurrent trigeminal neuralgia

Background. Re-do microvascular decompression (MVD) of the trigeminal nerve occasionally becomes necessary following recurrence of symptoms after a previous MVD. The indications include failure or contraindication of less invasive treatment options such as medication or trigeminal nerve lesioning and when supported by vascular compression on brain MRI scans.Purpose. To report on our findings following re-do MVD in the National Hospital for Neurology and Neurosurgery, Queen Square London from July 1995 to July 2008.Methods. Case note review of all patients who underwent re-do MVD for the above reasons in the senior author's series in the above institution and stated period. The parameters of study interest were pre-operative MRI features, operative findings, and complete pain-free period with regards to the first and re-do MVD.Results. Data analysis showed that 6 underwent a re-do MVD. Neurovascular conflict was confirmed in 5 cases (83.3%) involving the superior cerebellar artery and anterior inferior cerebellar artery in 2 cases each (33.3%) and ectatic basilar artery in 1 case (16.6%). Arachnoid adhesions around the previous teflon felt were also found in 5 cases (83.3%) mostly in association with other findings. Neo-arachnoid cyst formation in the corresponding cerebello-pontine angle, was an unexpected finding in 2 cases (33.3%), though of uncertain significance.Conclusion. Redo MVD should be considered as a safe and effective treatment option in recurrent trigeminal neuralgia, which fails to respond to non-surgical means.

Repeat microvascular decompression for hemifacial spasm

Objective: To report our experience with repeat microvascular decompression (MVD) for hemifacial spasm (HFS) in patients who have failed their first operation. Methods: The authors describe 41 redo MVDs for...

Microvascular Decompression for Trigeminal Neuralgia in Patients with Multiple Sclerosis

Aims: To assess whether microvascular decompression (MVD) is a safe and efficacious treatment for patients with trigeminal neuralgia (TGN) and multiple sclerosis (MS). Methods: Case records were reviewed of all patients with TGN and MS who underwent posterior fossa exploration with a view to MVD between 1993 and 2001. In all patients, magnetic resonance tomoangiography (MRTA) demonstrated vascular compression. Results: Nine patients were included in the study. Seven patients underwent MVD alone; in 2 patients a partial sensory rhizotomy of the trigeminal nerve was added to the decompression. All patients had excellent initial pain relief. Recurrence of neuralgia was noted in 5 patients after MVD and in 1 of the 2 patients after partial sensory rhizotomy. Long-term pain relief was obtained in 1 patient who underwent a redo MVD after postoperative MRTA scans demonstrated recurrent vascular compression of the root entry zone (REZ). Thus only 4 out of 9 patients maintained pain relief. In addition, 3 patients experienced transient worsening of their MS. Conclusions: Although MVD provides good initial pain relief, the recurrence rate is much higher than that obtained in ‘idiopathic’ TGN. Although all procedures for the treatment of TGN are worse than those for idiopathic TGN, it is concluded that because of the high recurrence rate together with the morbidity associated with the procedure MVD should not be offered to patients with TGN and MS.