Technical Nuances in Surgery for Recurrent Trigeminal Neuralgia

Background: Trigeminal neuralgia (TN) is caused by the compression of blood vessels against the trigeminal nerve.Microvascular decompression (MVD), in which blood vessels are moved to decompress the trigeminal nerve as a fundamental treatment, is the gold standard performed worldwide.In this study, we report our findings of reoperation and review the precautions for reoperation and procedures to prevent recurrence during the initial surgery.Materials and Methods: Twenty-five patients (5%) who underwent surgery for recurrent TN among 498 cases of MVD in the past seven years were included.Pre-and post-operative evaluations were performed using the Barrow Neurological Institute (BNI) score.A detailed evaluation of complications was performed.Results: Satisfactory results were obtained in 92% of the cases.Permanent neurological complications were not observed.The BNI-N evaluation revealed that five patients (20%) had grade I facial dysesthesia, two patients (8%) had very mild sensory disturbances (grade II), and one patient (4%) had moderate sensory disturbance (grade III).Conclusions: Aggressive surgical treatment should be considered in patients with recurrent TN.To prevent recurrence, minimal Teflon felt and fibrin glue should be used during the initial surgery without bleeding.