Posterior Fossa Reexploration for Persistent or Recurrent Trigeminal Neuralgia or Hemifacial Spasm: Surgical Findings and Therapeutic Implications

Posterior Fossa Reexploration for Persistent or Recurrent Trigeminal Neuralgia or Hemifacial... AbstractOBJECTIVETo evaluate the surgical findings and subsequent therapeutic implications of posterior fossa reexploration for persistent or recurrent trigeminal neuralgia (TN) or hemifacial spasm (HFS) after failed microvascular decompression (MVD).METHODSBetween December 1975 and October 1996, the senior author performed 31 reexplorations for failure or recurrence after MVD: 23 for TN and 8 for HFS. Records were analyzed retrospectively for evidence of vascular compression in primary and secondary operations, other pertinent intraoperative findings, intraoperative therapeutic interventions, and postoperative results and complications.RESULTSThe previously placed polyvinyl alcohol foam (Ivalon sponge; Unipoint Industries, High Point, NC) or Teflon implant (Teflon felt; CR Bard, Inc., Bard Implants Division, Billerica, MA) was found to be in good position in 100% of the patients (31 of 31 patients). New vascular compression from an arterial source was found in three patients during posterior fossa reexploration: one with TN and two with HFS. New vascular compression from a venous source was observed in one patient with HFS. A scarred Ivalon sponge or Teflon implant with apparent mass effect on the nerve root was identified in seven reexplorations. One bony source of compression was seen. No new compressive elements or other sources of root irritation were appreciated in 61% of reexplorations. Partial sensory trigeminal rhizotomy was performed in 83% of reexplorations for persistent or recurrent TN. Of eight patients undergoing reexploration for persistent or recurrent HFS, six sustained complications.CONCLUSIONRecurrent vascular compression was seldom identified during posterior fossa reexploration for failed MVD in patients with persistent or recurrent TN or HFS. The previously placed Ivalon sponge or Teflon implant was consistently found to be in good position. Partial sensory trigeminal rhizotomy is an often effective alternative in cases of recurrent TN when neurovascular compression is not identified. However, because of the relatively high incidence of complications associated with reexploration, we recommend other ablative or medical treatments for most patients after failed MVD for TN or HFS. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Posterior Fossa Reexploration for Persistent or Recurrent Trigeminal Neuralgia or Hemifacial Spasm: Surgical Findings and Therapeutic Implications

Posterior Fossa Reexploration for Persistent or Recurrent Trigeminal Neuralgia or Hemifacial Spasm: Surgical Findings and Therapeutic Implications

TECHNIQUE ASSESSMENT Posterior Fossa Reexploration for Persistent or Recurrent Trigeminal Neuralgia or Hemifacial Spasm: Surgical Findings and Therapeutic Implications Sohaib A. Kureshi, M.D., Robert H. Wilkins, M.D. Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina OBJECTIVE: To evaluate the surgical findings and subsequent therapeutic im plications of posterior fossa reexplora­ tion for persistent or recurrent trigeminal neuralgia (TN) or hem ifacial spasm (HFS) after failed m icrovascular decompression (M V D ). METHODS: Between Decem ber 1975 and O ctober 1996, the senior author performed 31 reexplorations for failure or recurrence after M V D : 23 for TN and 8 for H FS. Records were analyzed retrospectively for evidence of vascular compression in prim ary and secondary operations, other pertinent intraoperative findings, intraopera­ tive therapeutic interventions, and postoperative results and com plications. RESULTS: The previously placed polyvinyl alcohol foam (Ivalon sponge; Unipoint Industries, H igh Point, N C ) or Teflon implant (Teflon felt; C R Bard, Inc., Bard Implants D ivisio n, B illerica, MA) was found to be in good position in 100% of the patients (31 of 31 patients). New vascular compression from an arterial source was found in three patients during posterior fossa reexploration: one with TN and two with HFS. New vascular compression from a venous source was observed in one patient with H FS. A scarred Ivalon sponge or Teflon implant with apparent mass effect on the nerve root was identified in seven reexplorations. O ne bony source of compression was seen. No new compressive elements or other sources of root irritation were appreciated in 61 % of reexplorations. Partial sensory trigem inal rhizotom y was performed in 8 3 % of reexplorations for persistent or recurrent T N . O f eight patients undergoing reexploration for persistent or recurrent H FS, six sustained com plications. C...
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Publisher
Oxford University Press
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199811000-00061
Publisher site
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Abstract

AbstractOBJECTIVETo evaluate the surgical findings and subsequent therapeutic implications of posterior fossa reexploration for persistent or recurrent trigeminal neuralgia (TN) or hemifacial spasm (HFS) after failed microvascular decompression (MVD).METHODSBetween December 1975 and October 1996, the senior author performed 31 reexplorations for failure or recurrence after MVD: 23 for TN and 8 for HFS. Records were analyzed retrospectively for evidence of vascular compression in primary and secondary operations, other pertinent intraoperative findings, intraoperative therapeutic interventions, and postoperative results and complications.RESULTSThe previously placed polyvinyl alcohol foam (Ivalon sponge; Unipoint Industries, High Point, NC) or Teflon implant (Teflon felt; CR Bard, Inc., Bard Implants Division, Billerica, MA) was found to be in good position in 100% of the patients (31 of 31 patients). New vascular compression from an arterial source was found in three patients during posterior fossa reexploration: one with TN and two with HFS. New vascular compression from a venous source was observed in one patient with HFS. A scarred Ivalon sponge or Teflon implant with apparent mass effect on the nerve root was identified in seven reexplorations. One bony source of compression was seen. No new compressive elements or other sources of root irritation were appreciated in 61% of reexplorations. Partial sensory trigeminal rhizotomy was performed in 83% of reexplorations for persistent or recurrent TN. Of eight patients undergoing reexploration for persistent or recurrent HFS, six sustained complications.CONCLUSIONRecurrent vascular compression was seldom identified during posterior fossa reexploration for failed MVD in patients with persistent or recurrent TN or HFS. The previously placed Ivalon sponge or Teflon implant was consistently found to be in good position. Partial sensory trigeminal rhizotomy is an often effective alternative in cases of recurrent TN when neurovascular compression is not identified. However, because of the relatively high incidence of complications associated with reexploration, we recommend other ablative or medical treatments for most patients after failed MVD for TN or HFS.

Journal

NeurosurgeryOxford University Press

Published: Nov 1, 1998

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