Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, People's Republic of China.
Acta Neurochir (Wien). 2020 Nov;162(11):2783-2789. doi: 10.1007/s00701-020-04383-w. Epub 2020 May 8.
Microvascular decompression (MVD) is known as a safe and effective procedure to treat glossopharyngeal neuralgia (GN). However, some patients experienced poor pain relief after MVD, for which the mechanism is not clear yet. Reviewing the intraoperative findings and postoperative effect of reoperation for patients who failed the first MVD, is helpful to figure out why the first MVD for GN failed.
There were eight patients with GN who failed first MVD. The possibilities for secondary GN were eliminated by physical and radiological examination. The reoperation through the previous incision was conducted, and appropriately, treatment was provided according to the intraoperative findings. The video data and prognosis of the reoperation were retrospectively reviewed. The reasons for the invalid first MVD were analyzed.
To the end of follow-up, there were 7 patients of pain-free, and one patient with occasional mild pain attacks (VAS 2). There was one patient who experienced transient hoarseness in 3 months after the reoperation. We summarized the causes for failed first MVD which were omission of the offending vessel in 3 cases, inadequate decompression of the nerve root in 2 cases, and excessive decompression materials which caused iatrogenic nerve root compression in 3 cases.
For patients with recurrent or failed after MVD, a thorough examination should be carried out to eliminate the possibility of secondary GN. Reoperation through the previous incision is safe and effective. The bone window should be close enough to the sigmoid sinus to aid the exposure of the nerve root. The nerve transection could be adopted if no offending vessels were found. And a multi-site decompression could be used when the vertebral artery is the offending vessel.
微血管减压术（MVD）被认为是治疗舌咽神经痛（GN）的一种安全有效的方法。然而，一些患者在 MVD 后疼痛缓解不佳，其机制尚不清楚。回顾第一次 MVD 失败患者的术中发现和再次手术的效果，有助于了解为什么第一次 MVD 治疗 GN 失败。
有 8 例 GN 患者首次 MVD 失败。通过体格检查和影像学检查排除继发性 GN 的可能。经原切口再次手术，根据术中发现给予相应治疗。回顾性分析再次手术的视频资料和预后。分析第一次 MVD 无效的原因。
随访结束时，7 例患者疼痛完全缓解，1 例患者偶有轻度疼痛发作（VAS 2 分）。有 1 例患者在再次手术后 3 个月出现短暂性声音嘶哑。我们总结了第一次 MVD 失败的原因，其中 3 例为遗漏责任血管，2 例为神经根减压不充分，3 例为过度减压材料导致医源性神经根压迫。
对于 MVD 后复发或失败的患者，应进行彻底检查以排除继发性 GN 的可能性。经原切口再次手术是安全有效的。骨窗应尽可能靠近乙状窦，以利于神经根暴露。如果未发现责任血管，可以采用神经切断术。当椎动脉为责任血管时，可以采用多点减压。
