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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)

Also available at
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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
 

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