Posterior Fossa Re-Exploration for Recurrent Trigeminal Neuralgia: Operative Findings and Surgical Techniques

Objective: Microvascular decompression (MVD) is considered the first choice for the surgical treatment of trigeminal neuralgia (TN). However, recurrence after MVD is still a problem and a challenge for neurosurgeons. In this study, we share our experience in the posterior fossa re-exploration of the recurrent cases. Methods: From January 2014 to January 2015, 15 recurrent TN patients who received fossa re-exploration were retrospectively studied. Surgeries were performed by retrosigmoid suboccipital approach. Brainstem auditory evoked potentials (BAEP) were monitored throughout the operation. Intraoperative findings and surgical techniques were recorded. Postoperative outcomes and complications were analyzed. Results: Among the 15 patients, Teflon adhesion was found in 14. Teflon felt displacement was found in 4 patients, and additional Teflon felt was used to interpose. New offending vessels were found in 5 patients. Three of them were small arteries and the other 2 were petrosal veins. After dissected, small pieces of wet gelatin sponge and Teflon felt were implanted respectively to ensure complete decompression. The remaining 6 patients had no vascular compression except severe adhesion, and nerve combing was performed. After surgery, 12 achieved complete pain relief, 2 gained partial pain relief, and 1 failed. Six patients experienced facial numbness postoperatively. There was no hearing impairment or other complications. During the mean 26-month follow-up, no recurrence occurred and all of 6 cases with facial numbness after surgery improved. Conclusions: Teflon adhesion is a significant cause of recurrent TN. Wet gelatin-assisted method is good for Teflon interposition. If no vascular compression is found during re-exploration, trigeminal nerve combing can be used. Intraoperative BAEP monitoring is helpful to reduce the incidence of hearing loss. Address correspondence and reprint requests to Shi-Ting Li, MD, PhD, Department of Neurosurgery, Xin Hua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai Jiao Tong University School of Medicine, 1665 KongJiang Rd., Shanghai 200092, China; E-mail: lsting66@163.com Received 19 January, 2018 Accepted 8 February, 2018 Supported by a grant from Shanghai Jiao Tong University cross fund for medical engineering (#YG2016QN68, to Bao-hui Feng). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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