Evaluation of Microvascular Decompression as Rescue Therapy for Trigeminal Neuralgia in Patients with Failed Gamma Knife Surgery

Objective: Owing to increasing use of Gamma Knife surgery (GKS) for trigeminal neuralgia (TN), physicians are challenged over the problem of choosing an appropriate treatment if GKS fails. The aim of this study was to determine whether microvascular decompression (MVD) is a safe and effective alternative therapy for trigeminal neuralgia in patients with failed GKS.

Methods: Between January 1, 2010, and January 1, 2012, data of 32 patients with trigeminal neuralgia who presented with persistent or recurrent pain after GKS and elected to undergo MVD were collected. Clinical characteristics, operative findings, outcomes of MVD, and complications were reviewed.

Results: Mean interval time between GKS and MVD was 16 ± 5.64 months (range, 6-27 months). During MVD, the most common offending vessel was the superior cerebellar artery, followed by the anterior inferior cerebellar artery and vertebral artery. Immediately after MVD, 29 patients (90.63%) experienced complete pain relief without medication. At the end of the follow-up period, 25 patients were pain-free without medication.

Conclusions: Our data confirm that MVD is an effective and safe alternative therapy after GKS, although the risk of facial numbness seems higher in patients with a history of GKS than in patients without a history of GKS.