ArticleActa neurochirurgica2023
Microsurgical posterior fossa re-exploration for recurrent trigeminal neuralgia after previous microvascular decompression: common grounds-scarring, deformation, and the "piston effect".
Article in Acta neurochirurgica, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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10 citing papers in PubMed, 1 synthesis or guideline pooled it, 16 citations in OpenAlex.
- A systematic review on the efficacy of adjunctive surgical strategies during microvascular decompression for trigeminal neuralgia without intraoperative evidence of neurovascular conflict.Neurosurgical review · 2024Pooled it
- Surgical Management of Trigeminal Neuralgia Emerging in the Long-Term after Cerebellopontine Angle Tumor Surgery without Tumor Regrowth.Journal of neurological surgery. Part B, Skull base · 2026Article
- How I do it: microvascular decompression for classical trigeminal neuralgia by arterial compression.Acta neurochirurgica · 2026Article
- Historical evolution of microvascular decompression after Jannetta's establishment: Anatomical maps and physiological compasses-a narrative review.Acta neurochirurgica · 2026Review
- A comparison of long-term outcomes between interposition with teflon and autologous muscle in microvascular decompression for trigeminal neuralgia.Neurosurgical review · 2025Article
- Repeat posterior fossa exploration and external neurolysis for recurrent trigeminal neuralgia following microvascular decompression.Frontiers in surgery · 2025Article
- Pathophysiology and Management of Refractory Trigeminal Neuralgia.Current neurology and neuroscience reports · 2024Review
- Article
- Modern Approaches to the Treatment of Acute Facial Pain.Current pain and headache reports · 2024Review
- Identification of the leverage point in the offending artery.Acta neurochirurgica · 2024Article
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5 authors at 1 institution in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
objectiveMicrovascular decompression (MVD) is a well-accepted treatment modality for trigeminal neuralgia (TN) with high initial success rates. The causes for recurrence of TN after previously successful MVD have not been fully clarified, and its treatment is still a matter of debate. Here, we present the surgical findings and the clinical outcome of patients with recurrent TN after MVD who underwent posterior fossa re-exploration.
methodsMicrosurgical posterior fossa re-exploration was performed in 26 patients with recurrent TN (mean age 59.1 years) who underwent MVD over a period of 10 years. The trigeminal nerve was exposed, and possible factors for recurrent TN were identified. Arachnoid scars and Teflon granulomas were dissected meticulously without manipulating the trigeminal nerve. Outcome of posterior fossa re-exploration was graded according to the Barrow Neurological Institute (BNI) pain intensity score. Follow-up was analyzed postoperatively at 3, 12, and 24 months and at the latest available time point for long-term outcome.
resultsThe mean duration of recurrent TN after the first MVD was 20 months. Pain relief was achieved in all patients with recurrent TN on the first postoperative day. Intraoperative findings were as follows: arachnoid scar tissue in 22/26 (84.6%) patients, arterial compression in 1/26 (3.8%), venous contact in 8/26 (30.8%), Teflon granuloma in 14/26 (53.8%), compression by an electrode in Meckel's cave used for treatment of neuropathic pain in 1/26 (3.8%), evidence of pulsations transmitted to the trigeminal nerve through the Teflon inserted previously/scar tissue ("piston effect") in 15/26 (57.7%), and combination of findings in 18/26 (69.2%). At long-term follow-up (mean 79.5 months; range, 29-184 months), 21/26 (80.8%) patients had favorable outcome (BNI I-IIIa). New hypaesthesia secondary to microsurgical posterior fossa re-exploration occurred in 5/26 (19.2%) patients.
conclusionsPosterior fossa re-exploration avoiding manipulation to the trigeminal nerve, such as pinching or combing, may be a useful treatment option for recurrent TN after previously successful MVD providing pain relief in the majority of patients with a low rate of new hypaesthesia.
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