Recurrent trigeminal neuralgia at 20 years after surgery: case report.

Microvascular decompression (MVD) is now the most feasible method of treatment for trigeminal neuralgia (TN). The recurrence of symptoms is rarely encountered postoperatively. A female patient with typical right V3 distribution TN had been successfully treated by MVD at age 56 years by transposing the offending superior cerebellar artery, and she became completely pain-free postoperatively without sequelae. Twenty years after the first MVD, pain recurred on the right V2 distribution at age 76 years and she was operated on a second time to resolve the pain. Re-exploration surgery revealed that the trigeminal nerve was compressed mediocranially by the anterior inferior and posterior inferior cerebellar artery complex, which had not been close to the neural structure during the first surgery. The artery complex was successfully transpositioned to decompress the root exit zone (REZ) of the nerve and she became pain-free again. Although various causal factors likely contribute to recurrence of TN, the present case of recompression of a REZ occurred due to a newly developed offending artery which caused TN a long time after the first surgery.