Management of recurrent or persistent trigeminal neuralgia (TN) after microvascular decompression (MVD) is often difficult. The purpose of this systematic review is to objectively analyze and summarize the published literature on the feasibility of re-MVD. The authors conducted a database search using MEDLINE and PubMed databases from inception until July 2020. Of 1771 initial results obtained, the authors performed a full text screening of 43 studies and ultimately a total of 19 eligible studies were identified for final analysis. 2,247 patients underwent MVD surgery for trigeminal neuralgia, 311 of whom experienced recurrence, with a recurrence rate of 13.84%, Among 311 patients with recurrence, 178 received re-MVD surgery, The average pain-free interval was 27.75 months after the first MVD, the effective rate of re-MVD was 91.66%, and 71.48% of the patients had obvious compression found in operation. The postoperative complication rate of re-MVD was 37.31%, due to the postoperative adhesion around the nerve and nerve injury caused by PSR, the most common complication after re-MVD was facial numbness, accounting for 21.89%, except for facial numbness, the incidence of other complications was low, all of which were less than 5%.For patients with recurrent or persistent pain after MVD,this systematic review shows that repeated MVD remains a feasible treatment.
OBJECTIVE When conservative therapy fails, microvascular decompression (MVD) is the preferred treatment for primary trigeminal neuralgia (TN). However, management of recurrent or persistent trigeminal neuralgia (TN) after microvascular decompression (MVD) is often difficult. The purpose of this systematic review is to objectively analyze and summarize published literature regarding the feasibility of repeat MVD.
METHOD The authors conducted a database search using MEDLINE and PubMed databases until July 2020. The search terms used for title and abstract screening were as follow: “recurrent trigeminal neuralgia”, “persistent trigeminal neuralgia”, “repeat Microvascular Decompression” and “Re-Exploration”. Inclusion criteria for the systematic review were as follows: clinical studies (excluding case studies), repeat MVD treatment of TN, and studies that recorded pain relief outcomes, operative findings and complications (if any).
RESULTS Of the 1771 initial results obtained, the authors performed a full text screening of 43 studies and ultimately a total of 19 were deemed eligible. 2,247 patients underwent MVD surgery for trigeminal neuralgia, among whom, 311 experienced recurrences (13.84%). Of those patients, 178 received repeat MVD surgery, the average pain-free interval was 27.75 months after the first MVD. The effective rate of repeat MVD was 91.66%, and 71.48% of the patients had obvious compression found in operation. The postoperative complication rate of repeat MVD was 37.31%, due to postoperative adhesion around the nerve and nerve injury caused by PSR. The most common complication after repeat MVD was facial numbness (21.89%), and the incidence of other complications was less than 5%.
CONCLUSION For patients with recurrent or persistent pain after MVD,this systematic review supports that repeat MVD remains a feasible treatment.
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