Very early re-do microvascular decompression for patients with trigeminal neuralgia

Abstract

Although microvascular decompression (MVD) is the widely recognized surgical option for patient with trigeminal neuralgia (TN), and most patients could receive satisfactory outcome, some patients still complained of severe pain, with culprit vessel omission and incomplete decompression as the commonly mentioned reasons. Here we reported three cases of very early re-do MVD for patients with TN. We found that both artery and vein simultaneous compressed the trigeminal nerve, and tight adhesion was found between the vein and nerve. The artery was totally decompressed, but the vein could not be decompressed without affecting the blood flow due to the severe adhesion, the patients still complained of severe pain after the first surgery. Very early re-do MVD was performed and we totally separated the veins from the nerve. The symptoms of patients disappeared immediately without any complication. No recurrence was found during follow up. We conclude that culprit vein should be retained if possible, rather than sacrificed, and very early reoperation may be a feasible choice for patient with persistent symptom after MVD.