• Xin Zhang, Ling Xu, Hua Zhao, Yin-Da Tang, Jin Zhu, Yan Yuan, Ping Zhou, and Shi-Ting Li.
• Department of Neurosurgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Center for Diagnosis and Treatment of Cranial Nerve Diseases, Shanghai Jiao Tong University, Shanghai, China.
• World Neurosurg. 2017 Dec 1; 108: 711-715.

BackgroundMicrovascular decompression (MVD) of the trigeminal nerve is the most effective treatment for trigeminal neuralgia (TN). However, many patients respond poorly to initial MVD. For these patients, redo MVD is commonly done. There has been no research regarding the effectiveness of nerve combing (NC) plus MVD in patients with TN and failed prior MVD. We compared the clinical outcome of NC plus MVD and simple redo MVD in patients with TN and failed prior MVD.MethodsWe performed a retrospective analysis of 148 patients with recurrent or persistent TN symptoms who underwent surgery between January 2007 and December 2015. Simple MVD was performed in 62 patients, and NC plus MVD was performed in 86 patients.ResultsFor simple MVD, success rates at 1 day, 7 days, 1 month, 3 months, and 1 year after surgery all were approximately 80%. Success rates of NC plus MVD were significantly (P < 0.05) higher than success rates of simple MVD, by 17.02%, 18.64%, 16.47%, 17.21%, and 14.80% at 1 day, 7 days, 1 month, 3 months, and 1 year. The incidence rates of facial numbness in the simple MVD group were 48.39%, 45.16%, 36.67%, 16.95%, and 1.75% at 1 day, 7 days, 1 month, 3 months, and 1 year; the incidence rates in the NC plus MVD group were 60.47%, 55.81%, 48.24%, 21.69%, and 3.75% (P > 0.05).ConclusionsIn patients with TN who failed prior MVD, NC plus MVD significantly improved the success rate of the operation compared with simple redo MVD. We obtained good short-term and long-term surgical outcomes with NC combined with MVD.Copyright © 2017 Elsevier Inc. All rights reserved.

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