Outcomes and safety of repeated microvascular decompression for recurrent trigeminal neuralgia.

objectiveRecurrent Trigeminal Neuralgia (TN) poses significant challenges for treatment, often necessitating repeated Microvascular Decompression (MVD). This study aims to evaluate the safety, efficacy, and prognostic factors associated with repeated MVD for recurrent TN at our institution. A retrospective review was conducted on 147 patients who underwent repeated MVD between September 2010 and September 2023. Data on surgical procedures, postoperative outcomes, and recurrence rates were collected. The primary endpoint was recurrent pain. Univariate and multivariate Cox proportional hazards analyses were used to identify predictors of pain recurrence. In this cohort, 147 patients underwent revision surgery, comprising 97 females and 50 males. The primary reason for the nonresolution in 96 patients was adhesions of Teflon pledgets to the trigeminal nerve, while in 51 patients, previously missed vascular compression was identified. After a median follow-up of 53.3 months, 14 patients were lost to follow-up. Twelve patients (9.0%) reported no pain relief after repeated MVD, while 121 patients (91.0%) achieved complete pain relief. The most common complication was facial numbness, occurring in 101 cases (68.7%), followed by blurred vision (11 patients, 7.5%), hearing impairment (8 patients, 5.4%), poor wound healing (2 patients, 1.4%), postoperative stroke confirmed by CT imaging (2 patients, 1.4%) and permanent ataxia (2 patients, 1.4%). The mortality rate for repeated MVD at our center was zero. Twenty-four patients (19.8%) experienced pain recurrence, with a median pain-free survival (PFS) of 36.0 months. The 5- and 10-year PFS rates were 80.8% and 54.5%, respectively. Patients who underwent combined partial sensory rhizotomy (PSR) and MVD (Hazard Ratio [HR] 0.203, 95% Confidence Interval [CI] 0.047-0.882, p = 0.033) or circumferential dissection and MVD (HR 0.295, 95% CI 0.099-0.882, p = 0.029) had lower recurrence rates compared to MVD alone. Long-term facial numbness was the most common complication, particularly in patients undergoing PSR. Repeated MVD is effective and safe for recurrent TN. PSR with MVD is associated with lower rate of TN recurrence but increases the risk of facial numbness. Conversely, circumferential dissection is associated with lower recurrence rates without increasing postoperative facial numbness. CLINICAL TRIAL NUMBER: Not applicable.