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Redo surgery for trigeminal neuralgia: reasons for re-exploration and long-term outcomes

  • Original Article - Functional Neurosurgery - Pain
  • Published:
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Abstract

Background

To investigate the causes of failure and recurrence after microvascular decompression (MVD) for trigeminal neuralgia (TGN) and to analyze the results of redo surgery.

Methods

Sixty-three cases of redo surgery were retrospectively reviewed. Reasons for re-exploration were categorized into 4 groups based on the operative findings. Patient characteristics, outcomes of re-exploration, and operative complications were analyzed by Kaplan–Meier and logistic regression analyses.

Results

Reasons for redo surgery were divided into arterial compression in 13 patients (21%), venous compression in 11 patients (17%), prosthesis-related in 25 patients (40%), and adhesion or negative exploration in 14 patients (22%). Immediate pain relief was obtained in 59 patients (94%) postoperatively with newly developed facial numbness in 17 patients (27%). Of these, 48 patients (76%) maintained pain-free 1 year postoperatively. Overall recurrence was noted in 17 patients (27%) during the median 49-month follow-up period. Most recurrences occurred within 1 year after redo surgery, but the prosthesis-related patients showed a continuous recurrence up to 4 years. Patients having vascular compression showed significantly better pain control than those without vascular contact in Kaplan–Meier analyses (p = 0.0421). No prognostic factor for pain-free 1 year after redo surgery was found.

Conclusions

Redo surgery is effective for patients with remaining vascular compression rather than those without vascular contact. Teflon contact onto the nerve root should be avoided because it is a potential risk for recurrence and causes poor prognosis after redo surgery.

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Acknowledgements

We thank Ms. Satomi Fujimura and Ms. Yasuko Noda for assistance with data collection.

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Authors and Affiliations

  1. Department of Neurosurgery, Koto Memorial Hospital, Shiga, Japan

    Takuro Inoue, Satoshi Shitara & Yukihiro Goto

  2. Department of Neurosurgery, National Brain Center Hospital, Jakarta, Indonesia

    Mustaqim Prasetya

  3. Raleigh Neurosurgical Clinic, Raleigh, NC, USA

    Lori Radcliffe

  4. Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA

    Takanori Fukushima

Authors
  1. Takuro Inoue
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  2. Satoshi Shitara
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  3. Yukihiro Goto
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  4. Mustaqim Prasetya
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  5. Lori Radcliffe
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  6. Takanori Fukushima
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Corresponding author

Correspondence to Takuro Inoue.

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This article is part of the Topical Collection on Functional Neurosurgery - Pain

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Inoue, T., Shitara, S., Goto, Y. et al. Redo surgery for trigeminal neuralgia: reasons for re-exploration and long-term outcomes. Acta Neurochir 163, 2407–2416 (2021). https://doi.org/10.1007/s00701-021-04920-1

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  • DOI: https://doi.org/10.1007/s00701-021-04920-1

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