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J Neurol Surg B Skull Base 2019; 80(01): 031-039
DOI: 10.1055/s-0038-1661348
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Revision Microvascular Decompression for Trigeminal Neuralgia and Hemifacial Spasm: Factors Associated with Surgical Failure

Kristine Ravina
1   Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
,
Ben A. Strickland
1   Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
3   Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United Sates
,
Robert C. Rennert
2   Department of Neurosurgery, University of California, San Diego, San Diego, California, United States
,
Joshua Bakhsheshian
3   Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United Sates
,
Jonathan J. Russin
1   Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
3   Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United Sates
,
Steven L. Giannotta
3   Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United Sates
› Author Affiliations
Further Information

Publication History

16 April 2018

11 May 2018

Publication Date:
29 June 2018 (online)

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Abstract

Objective To investigate risk factors for symptom recurrence in patients requiring a revision microvascular decompression (MVD) for trigeminal neuralgia (TN) or hemifacial spasm (HFS).

Design Retrospective review of a prospectively maintained database.

Participants Seventeen consecutive patients undergoing revision MVD at our institution between January 1993 and September 2017.

Main Outcome Measures The incidence and causes for revision MVDs were recorded. Response to revision MVD for TN was tracked using the Barrow Neurological Institute (BNI) grading scale. Response to revision MVD for HFS was graded as “no improvement,” “some relief,” or “complete resolution” of symptoms.

Results Revision MVD rate for the senior author across all MVDs performed in this period was 1.9% for TN and 9.3% for HFS. Initial MVD failure was primarily caused by active inflammation and/or scarring and adhesions in 5/17 patients, malposition/slippage of Teflon in 3/17 patients, and insufficient Teflon in 1/17 patients. Without other factors, a new site of neurovascular conflict was identified in 4/17 patients, while the same site of neurovascular conflict was found in 3/17 patients. No cause could be identified in 1/17 patients. Scarring was found primarily in the TN group and was associated with symptom persistence.

Conclusion Revision MVD for recurrent TN and HFS is an effective procedure offering the prospect of a complete cure. Proper Teflon use is crucial for surgical success. Scarring after initial MVD is a negative prognostic factor requiring destructive treatment consideration. Although morbidity rates were slightly increased with revision versus original MVDs, the complications were non-disabling and resolved over time.

Keywords

hemifacial spasm - microvascular decompression - neurovascular conflict - reoperation - trigeminal neuralgia
 

  • References

  • 1 Quinones-Hinojosa A. Schmidek & Sweet Operative Neurosurgical Techniques: Indications, Methods, and Results. 6th ed. Philadelphia: Saunders; 2012
    Google Scholar
  • 2 Cruccu G, Finnerup NB, Jensen TS. , et al. Trigeminal neuralgia: new classification and diagnostic grading for practice and research. Neurology 2016; 87 (02) 220-228
    CrossrefPubMedGoogle Scholar
  • 3 Cruccu G, Gronseth G, Alksne J. , et al; American Academy of Neurology Society; European Federation of Neurological Society. AAN-EFNS guidelines on trigeminal neuralgia management. Eur J Neurol 2008; 15 (10) 1013-1028
    CrossrefPubMedGoogle Scholar
  • 4 Miller LE, Miller VM. Safety and effectiveness of microvascular decompression for treatment of hemifacial spasm: a systematic review. Br J Neurosurg 2012; 26 (04) 438-444
    CrossrefPubMedGoogle Scholar
  • 5 Barker II FG, Jannetta PJ, Bissonette DJ, Shields PT, Larkins MV, Jho HD. Microvascular decompression for hemifacial spasm. J Neurosurg 1995; 82 (02) 201-210
    CrossrefPubMedGoogle Scholar
  • 6 Nielsen VK. Pathophysiology of hemifacial spasm: I. Ephaptic transmission and ectopic excitation. Neurology 1984; 34 (04) 418-426
    CrossrefPubMedGoogle Scholar
  • 7 Nurmikko TJ, Eldridge PR. Trigeminal neuralgia--pathophysiology, diagnosis and current treatment. Br J Anaesth 2001; 87 (01) 117-132
    CrossrefPubMedGoogle Scholar
  • 8 Liu M, Xia L, Zhong J, Li B, Dou N, Li S. What should we do for those hemifacial spasm patients without efficacy following microvascular decompression: expectation of delayed relief or early reoperation?. World Neurosurg 2018; 110: 897-900
    CrossrefPubMedGoogle Scholar
  • 9 Zhong J, Xia L, Dou NN. , et al. Delayed relief of hemifacial spasm after microvascular decompression: can it be avoided?. Acta Neurochir (Wien) 2015; 157 (01) 93-98 , discussion 98–99
    CrossrefPubMedGoogle Scholar
  • 10 Shin HS, Lee SH, Ko HC, Koh JS. Evaluating transient hemifacial spasm that reappears after microvascular decompression specifically focusing on the real culprit location of vascular compression. World Neurosurg 2017; 98: 774-779
    CrossrefPubMedGoogle Scholar
  • 11 Bigder MG, Kaufmann AM. Failed microvascular decompression surgery for hemifacial spasm due to persistent neurovascular compression: an analysis of reoperations. J Neurosurg 2016; 124 (01) 90-95
    CrossrefPubMedGoogle Scholar
  • 12 Taylor JC, Brauer S, Espir ML. Long-term treatment of trigeminal neuralgia with carbamazepine. Postgrad Med J 1981; 57 (663) 16-18
    CrossrefPubMedGoogle Scholar
  • 13 Barker II FG, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 1996; 334 (17) 1077-1083
    CrossrefPubMedGoogle Scholar
  • 14 Tatli M, Satici O, Kanpolat Y, Sindou M. Various surgical modalities for trigeminal neuralgia: literature study of respective long-term outcomes. Acta Neurochir (Wien) 2008; 150 (03) 243-255
    CrossrefPubMedGoogle Scholar
  • 15 Amador N, Pollock BE. Repeat posterior fossa exploration for patients with persistent or recurrent idiopathic trigeminal neuralgia. J Neurosurg 2008; 108 (05) 916-920
    CrossrefPubMedGoogle Scholar
  • 16 Kalkanis SN, Eskandar EN, Carter BS, Barker II FG. Microvascular decompression surgery in the United States, 1996 to 2000: mortality rates, morbidity rates, and the effects of hospital and surgeon volumes. Neurosurgery 2003; 52 (06) 1251-1261 , discussion 1261–1262
    CrossrefPubMedGoogle Scholar
  • 17 Bakker NA, Van Dijk JM, Immenga S, Wagemakers M, Metzemaekers JD. Repeat microvascular decompression for recurrent idiopathic trigeminal neuralgia. J Neurosurg 2014; 121 (04) 936-939
    CrossrefPubMedGoogle Scholar
  • 18 Rogers CL, Shetter AG, Fiedler JA, Smith KA, Han PP, Speiser BL. Gamma knife radiosurgery for trigeminal neuralgia: the initial experience of the Barrow Neurological Institute. Int J Radiat Oncol Biol Phys 2000; 47 (04) 1013-1019
    CrossrefPubMedGoogle Scholar
  • 19 Kano H, Kondziolka D, Yang HC. , et al. Outcome predictors after gamma knife radiosurgery for recurrent trigeminal neuralgia. Neurosurgery 2010; 67 (06) 1637-1644 , discussion 1644–1645
    CrossrefPubMedGoogle Scholar
  • 20 Li ST, Pan Q, Liu N, Shen F, Liu Z, Guan Y. Trigeminal neuralgia: what are the important factors for good operative outcomes with microvascular decompression. Surg Neurol 2004; 62 (05) 400-404 , discussion 404–405
    CrossrefPubMedGoogle Scholar
  • 21 Capelle HH, Brandis A, Tschan CA, Krauss JK. Treatment of recurrent trigeminal neuralgia due to Teflon granuloma. J Headache Pain 2010; 11 (04) 339-344
    CrossrefPubMedGoogle Scholar
  • 22 Cheng J, Liu W, Hui X, Lei D, Zhang H. Microvascular decompression for trigeminal neuralgia in patients with failed gamma knife surgery: analysis of efficacy and safety. Clin Neurol Neurosurg 2017; 161: 88-92
    CrossrefPubMedGoogle Scholar
  • 23 Kang IH, Park BJ, Park CK, Malla HP, Lee SH, Rhee BA. A clinical analysis of secondary surgery in trigeminal neuralgia patients who failed prior treatment. J Korean Neurosurg Soc 2016; 59 (06) 637-642
    CrossrefPubMedGoogle Scholar
  • 24 Dou NN, Zhong J, Liu MX. , et al. Teflon might be a factor accounting for a failed microvascular decompression in hemifacial spasm: a technical note. Stereotact Funct Neurosurg 2016; 94 (03) 154-158
    CrossrefPubMedGoogle Scholar
  • 25 Chen J, Lee S, Lui T, Yeh Y, Chen T, Tzaan W. Teflon granuloma after microvascular decompression for trigeminal neuralgia. Surg Neurol 2000; 53 (03) 281-287
    CrossrefPubMedGoogle Scholar
  • 26 Matsushima T, Yamaguchi T, Inoue TK, Matsukado K, Fukui M. Recurrent trigeminal neuralgia after microvascular decompression using an interposing technique. Teflon felt adhesion and the sling retraction technique. Acta Neurochir (Wien) 2000; 142 (05) 557-561
    CrossrefPubMedGoogle Scholar
  • 27 Toth G, Rubeiz H, Macdonald RL. Polytetrafluoroethylene-induced granuloma and brainstem cyst after microvascular decompression for trigeminal neuralgia: case report. Neurosurgery 2007; 61 (04) E875-E877 , discussion E877
    CrossrefPubMedGoogle Scholar
  • 28 de Vries J, Menovsky T, van Gulik S, Wesseling P. Histological effects of fibrin glue on nervous tissue: a safety study in rats. Surg Neurol 2002; 57 (06) 415-422 , discussion 422
    CrossrefPubMedGoogle Scholar