Effects of microvascular decompression plus longitudinal nerve sectioning on recurrent trigeminal neuralgia and investigations of postoperative recurrence causes

Recurrent trigeminal neuralgia (RTN) is a challenge for neurosurgeons. It is challenging to develop an appropriate treatment method for patients who respond poorly to initial therapies. This study aimed to investigate the causes of RTN and to evaluate the efficacy of microvascular decompression (MVD) plus longitudinal nerve sectioning (LNS) or LNS only for RTN patients who have received multiple procedures. 21 patients underwent MVD plus LNS or LNS only at our institute from June 2008 to December 2014. Patients were retrospectively studied and analyzed. The patients' data were collected: age, sex , treatment before surgery, pain severity and distribution, findings during surgery, immediate postoperative BNI (Barrow Neurological Institute score system), final follow-up BNI,complications and associated comorbidities. Vascular compression, arachnoid adhesion and Teflon granulomas were the primary causes of recurrent TN. After MVD plus LNS or LNS only treatments, almost all patients (19/21, 90.5%) reported pain relief after 36.1 months. Of these patients, 15 patients (71.4%) reported being pain-free (BNI score I) and 4 patients (19.1%) reported pain relief (BNI II-III). Two patients reported a pain level of BNI IV. However, almost all patients was left with some degree of numbness. This study certified that vascular compression, arachnoid adhesion and Teflon granulomas were the reasons for recurrent trigeminal neuralgia. MVD plus LNS or LNS only were both feasible therapeutic options, with good probabilities of success, especially after multiple neurodestructive procedures.