Analysis of Failed Microvascular Decompression in Patients with Trigeminal Neuralgia

Abstract

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.

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

“…Offending vessel could be perforator that encircle the nerve, which is one of the common causes of difficult MVD and result in incomplete decompression. 13 Huang et al 14 and Cho et al 15 reported high rate of incomplete decompression in failed MVD and proposed that it was one of the main causes of the surgical failure providing support for the need of repeat MVD. Lee et al classified the possible causes of MVD failure into three categories, offending vessel omission, insufficient decompression and untouched NVC site.…”

Compression Degree of Trigeminal Nerve and Type of Conflicting Vessels Determine Short- and Long-Term Complete Pain Relief in Adult Patients with Primary Trigeminal Neuralgia After Microvascular Decompression: A Three-Year Retrospective Study of 200 Adult Patients with Primary Trigeminal Neuralgia

“…[27][28][29][30] Sufficient decompression of TN and thorough exploration of both sensory and motor roots during MVD is a prerequisite to obtaining optimal pain relief in adult patients with PTN. 31 The main purpose of this study is derived from this clinical fact that it is still unclear why a sizable portion of adult PTN patients with explicit NVC are unable to obtain satisfactory shortand long-term CPR even after sufficient decompression of TN during MVD. According to reports, MVD has a recurrence rate of about 10%, which is significantly lower than that of traditional pharmacotherapy and other neurosurgical interventions, with non-arterial compression being one of the contributing factors.…”