Author(s): Hussain M.; Sunderland G.; Franceschini P.; Konteas A.; Byrne P.; Farah J.; Eldridge P.
Source: British Journal of Neurosurgery; 2018; vol. 32 (no. 1); p. 102
Publication Date: 2018
Publication Type(s): Conference Abstract
Abstract:Objectives: 478 procedures have been recorded for trigeminal neuralgia in this centre. In this study we aim to evaluate the outcomes of Re-exploration surgery for microvascular decompression (re-MVD) of the trigeminal nerve. Methods: Retrospective analysis of case notes, and recording the outcomes of facial pain using the Barrow Neurological Institute Pain Scale (BNI-PS). Results: Over a 10 year period 32 re-MVD procedures were performed with BAER monitoring in all cases. Notes were available for 30 of which there were 5 male and 25 female patients. All patients had undergone a MVD previously, and had a BNI-PS score of IV or V prior to re-MVD. 4 patients continued to score IV-V after surgery and remaining improved to III or better. However only 15 patients became pain free after the operation, 10 of which no longer required any medication. The most consistent intra-operative finding was that of scarring and distortion of the Trigeminal nerve. In 11 patients intra-operative neurolysis was performed and 7 of these patients were pain free post op. There were no major complications recorded in this cohort. Conclusions: Re-exploration of MVD, with or without neurolysis, is a safe procedure with the appropriate monitoring during surgery. There is a 50% chance of being pain free post-surgery however 1/3 of these patients still required medication. With correct patient selection, this method of treatment is an option for patients with refractory pain following initial successful treatment with micro-vascular decompression.