Effects of microvascular decompression plus longitudinal nerve sectioning on recurrent trigeminal neuralgia and investigations of postoperative recurrence causes

Abstract

AIM: To investigate the causes of recurrent trigeminal neuralgia (RTN) and to evaluate the efficacy of microvascular decompression (MVD) plus longitudinal nerve sectioning (LNS) or LNS only for RTN patients who have undergone multiple procedures. MATERIAL and METHODS: Twenty one patients underwent MVD plus LNS or LNS only at our institute from June 2008 to December 2014. The patients were retrospectively reviewed and analyzed. The following data were collected: age, sex, treatment before surgery, pain severity and distribution, findings during surgery, immediate postoperative BNI (Barrow Neurological Institute score system), final follow-up BNI, complications and associated comorbidities. RESULTS: Vascular compression, arachnoid adhesion and Teflon granulomas were the primary causes of RTN. After MVD plus LNS or LNS only treatments, almost all patients (19/21, 90.5%) reported pain relief after 36.1 months. Of these patients, 15 patients (71.4%) reported being pain-free (BNI score I) and 4 patients (19.1%) reported pain relief (BNI II-III). Two patients reported a pain level of BNI IV. However, almost all patients were left with some degree of numbness. CONCLUSION: This study certified that vascular compression, arachnoid adhesion and Teflon granulomas were the reasons for RTN. MVD plus LNS or LNS only were both feasible therapeutic options, with good probabilities of success, especially after multiple neurodestructive procedures.