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J Neurol Surg B Skull Base 2020; 81(05): 567-571
DOI: 10.1055/s-0039-1692683
Original Article

Analysis of Failed Microvascular Decompression in Patients with Trigeminal Neuralgia

Zhenyu Huang‡  
1   Department of Neurological Surgery, Shanghai Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
,
Benfang Pu‡  
1   Department of Neurological Surgery, Shanghai Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
,
Fusheng Li‡  
1   Department of Neurological Surgery, Shanghai Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
,
KaiZhang Liu‡  
1   Department of Neurological Surgery, Shanghai Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
,
Chunhui Hua
1   Department of Neurological Surgery, Shanghai Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
,
Changhua Li
1   Department of Neurological Surgery, Shanghai Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
,
Changyi Zhao
1   Department of Neurological Surgery, Shanghai Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
,
Jie Li
1   Department of Neurological Surgery, Shanghai Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
,
Xinyuan Li
1   Department of Neurological Surgery, Shanghai Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
› Institutsangaben Funding This study was supported by the grant from Shanghai Municipal Commission of Health and Family Planning (201540299, to Li Xinyuan) and by Medical Engineering Cross Fund of Shanghai Jiaotong University (YG2016MS67, to Li Xinyuan).
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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.

Keywords

trigeminal neuralgia - microvascular decompression - reoperation - motor root - offending vessel

Ethical Approval

The clinical data were retrospectively reviewed. For this type of study, formal consent is not required.


* These authors contributed equally to this study.




Publikationsverlauf

Eingereicht: 28. Januar 2019

Angenommen: 11. Mai 2019

Artikel online veröffentlicht:
01. Juli 2019

Georg Thieme Verlag KG
Stuttgart · New York

 

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