Classical trigeminal neuralgia recurrence after vascular decom - pression: analysis of the causes and features of the clinical picture

Introduction. Pain syndrome recurrence in patients with classical trigeminal neuralgia (CTN) after surgical treatment is an important and relevant issue, despite the advances in the diagnosis of the disease, progress in approaches to patient selection, and proven surgical tactics. The aim of the study is to evaluate the affecting factors for redo surgery in patients with CTN recurrence. Materials and methods. 257 patients with CTN recurrence operated on at the FSAI N.N. Burdenko National Medical Research Center for Neurosurgery of the Ministry of Health of the Russian Federation for the period from 2012 to 2017 were involved in the prospective nonrandomized study. Intraoperative findings and pain structure in postoperative period were evaluated in patients after revision surgery. Burchiel classification, DN4 Questionnarie, and Barrow Neurological Institute Pain Intensity Score (BNI-PS) were used. Results. CTN recurrence in the early and late post-operative periods was registered in 33 patients, which accounted for 13% of the total number of patients in the study group. 58% of them underwent secondary surgical intervention. The efficacy of redo surgery was noted in 79% of patients with complete regression of pain. Patients with CTN and neuropathy combination were admitted to alternative methods (neuromodulation, radiosurgery, radiofrequency ablation). In patients who received stimulation of the branches of the trigeminal nerve after vascular decompression, pain regression was observed in 100% of cases. Patient distribution after combined treatment was 78% for BNI-PS score I and 22% for BNI-PS score 2-3, respectively. Conclusion. In patients with “pure” CTN recurrence, redo surgery presents an effective method of treatment. In patients with CTN and neuropathy combination, repeat vascular decompression is effective only in terms of paroxysmal pain. Thus, multidisciplinary approach is needed – combining adjunctive methods of treatment in neurology, neurosurgery, pain management, and radiotherapy.