Abstract

Trigeminal neuralgia (TN) is a debilitating disorder manifesting as intense lancinating pain in in the distribution of the trigeminal nerve. Microvascular decompression (MVD) of the trigeminal nerve has become the first choice for patients with TN refractory to medication as it is effective and durable with initial pain relief reported as high as 98% however recurrence of TN pain has been reported as high as 47% at 8.5 years follow up. The long-term efficacy remains significantly higher than percutaneous neuroablative techniques with recurrence rates reported as high as 75% within 5 years. Recurrence of TN following MVD poses a management challenge with no evidence-based guidelines for treatment. Initial series of repeat MVD describe high complication rates which, combined with high negative exploration rates for neurovascular conflicts, led authors to favor percutaneous interventions for medically refractory cases. This report describes three cases and reviews the current literature. Recent literature indicates that the predominant causes of recurrent TN are adhesions around the graft, the development of a Teflon granuloma or recurrent vascular compression. The cases reported here support the recommendation that repeat MVD can be highly effective in alleviating recurrent TN whether the recurrent compression is due to the prosthesis or recurrent vascular compression.

Keywords: Trigeminal neuralgia; Microvascular decompression; Facial pain