The Causes And Surgical Managements Of Recurrent Trigeminal Neuralgia

Objectives:To analyze the causes of the recurrent trigeminal neuralgia,and to evaluate the outcomes of three kinds of surgeries for the recurrent trigeminal neuralgia.Methods:Thirty-three cases,diagnosed of recurrent trigeminal neuralgia in the Ninth People's Hospital affiliated to Shanghai JiaoTong University during 2010.6 to 2014.6 were retrospectively analyzed.All the patients accepted the surgeries as the treatments,including microvascular decompression in twenty cases,microvascular decompression combined with internal neurolysis in nine cases,and trigeminal sensory fiber combing in four cases.The medical history,imaging data and surgical video records of the patients were collected and analyzed.Results:According to the intraoperative findings,in all the patients studied,the incidence of vascular compression was 87.9%(29/33),the incidence of arachnoid thickening was 75.8%(25/33),and the incidence of teflon granuloma was 3.0%(1/33).After the surgeries,i)twenty cases taken microvascular decompression were followed up 32 ± 11.2 mo.And the cure rate was 70%(14/20),the markedly effective rate was 20.0%(4/20),the effective rate was 5.0%(1/20),and the recurrence rate was 5.0 %(1/20).ii)Nine cases of microvascular decompression combined with internal neurolysis,were followed up 37.1±17.7 mo.And the cure rate was 66.9%(6/9),the markedly effective rate was 20.0%(4/20),the effective rate was 22.2%(2/9),and the recurrence rate was 11.1%(1/9).iii)Four cases of trigeminal sensory fiber combing,were followed up 33.8 ± 10.2 mo.And the cure rate was 75%(3/4),the effective rate was 25.0%(1/4).Conclusion:Vascular compression and arachnoid adhesions were considered to be the main causes of the recurrent trigeminal neuralgia,followed by Telfon granuloma.Patients with recurrent trigeminal neuralgia could take the surgeries of microvascular decompression,microvascular decompression combined with internal neurolysis,or trigeminal sensory fiber combing as the effective managements to relieve the pain.