Improving treatment strategies for recurrent classic trigeminal neuralgia

Abstract

Objective: to study the pathogenesis of recurrent classical trigeminal neuralgia and to improve the methods of its treatment.

Material and methods: the study included 20 patients of various ages, with a predominance of female participants, diagnosed with recurrent neurovascular compression of the trigeminal nerve based on MRI findings. 17 patients underwent microvascular decompression surgery. To enhance treatment efficacy and reduce recurrence rates, complete separation and isolation of the nerve root were performed using a Teflon pad, TachoComb hemostatic sponge, and adipose tissue.

Results: postoperatively, all operated patients (100%) experienced complete resolution of pain. Three patients were identified as having a neuropathic pain component and responded well to conservative therapy. Surgical efficacy was assessed objectively by the absence of facial pain. Additional assessment tools included the Barrow Neurological Institute Pain Scale (BNI-PS) and the Visual Analogue Scale (VAS). The average postoperative follow-up period was 1.5 years, during which no patient reported recurrence of facial pain.

Conclusions: the most common cause of recurrent neurovascular compression of the trigeminal nerve was postoperative adhesion formation. Other frequent causes include inadequate isolation of the nerve from cerebral vascular structures and displacement of the Teflon implant. To reduce recurrence rates, it is essential to prevent postoperative adhesions at the surgical site and to ensure complete separation and reliable insulation of the nerve not only from the compressing vessel but also from adjacent cerebral structures, including neighboring cranial nerves.