Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai, China.
Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai, China.
World Neurosurg. 2024 Jun;186:e335-e341. doi: 10.1016/j.wneu.2024.03.131. Epub 2024 Mar 27.
Microvascular decompression (MVD) is an effective nondestructive neurosurgical procedure for trigeminal neuralgia (TN). However, some patients may undergo surgery failure or experience pain recurrence, sparking debates on the need for reoperation.
We conducted a retrospective analysis of 103 cases of patients with primary TN who underwent redo MVD at our center between January 2020 and December 2022. Comparative prognostic assessments were performed by comparing these cases against a cohort of 348 patients who underwent primary MVD during the same study period.
During the redo MVD cases, arachnoid membranes adhesions (80.6%) and Teflon adhesions with/without granuloma (86.4%) as well as remaining vascular compression (36.9%) were observed. After the reoperation, an immediate relief rate of 94.2% was observed. During a mean follow-up period of 17.4 ± 4.4 months, a long-term relief rate of 89.3% was achieved. Postoperative complications included 3 cases of persistent paresthesia, 1 case each of hearing loss, cerebrospinal fluid leak, and facial palsy. Ten cases without evident compression received nerve combing and all experienced immediate complete relief, with only 1 patient experiencing recurrence 9 months after surgery. Compared to the primary MVD group, the reoperation group had a higher average age, longer disease duration, and operating time (P < 0.05). However, there were no significant differences in immediate relief rate, long-term relief rate, or complications between the 2 groups. The main cause of persistent symptom was inadequate decompression, such as missing the offending vessel; while the recurrent was primarily due to Teflon adhesion or granuloma formation.
The redo MVD for TN is equally efficacious and safe compared to the primary procedure, with an emphasis on meticulous dissection and thorough decompression. Additionally, nerve combing proves to be an effective supplementary option for patients without obvious compression.
微血管减压术（MVD）是治疗三叉神经痛（TN）的一种有效、非破坏性的神经外科手术。然而，一些患者可能会经历手术失败或疼痛复发，这引发了是否需要再次手术的争论。
我们对 2020 年 1 月至 2022 年 12 月期间在我们中心接受再次 MVD 的 103 例原发性 TN 患者进行了回顾性分析。通过将这些病例与同期接受初次 MVD 的 348 例患者进行比较，对其进行了预后评估。
在再次 MVD 病例中，蛛网膜膜粘连（80.6%）、特氟隆粘连伴/不伴肉芽肿（86.4%）以及仍然存在血管压迫（36.9%）。再次手术后，即刻缓解率为 94.2%。在平均 17.4±4.4 个月的随访期间，长期缓解率为 89.3%。术后并发症包括 3 例持续性感觉异常、1 例听力损失、1 例脑脊液漏和 1 例面瘫。10 例无明显压迫的患者接受神经梳理，所有患者均立即完全缓解，仅 1 例患者在术后 9 个月复发。与初次 MVD 组相比，再次手术组的平均年龄更高、疾病持续时间更长、手术时间更长（P<0.05）。然而，两组之间的即刻缓解率、长期缓解率或并发症发生率无显著差异。持续性症状的主要原因是减压不充分，如遗漏致病血管；而复发主要是由于特氟隆粘连或肉芽肿形成。
与初次手术相比，再次 MVD 治疗 TN 同样有效且安全，需要强调精细的解剖和彻底的减压。此外，神经梳理对于没有明显压迫的患者是一种有效的补充选择。
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