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Recurrent TN attributable to veins after MVD

I found this article and it pertains to me, specifically my compression by a vein and my recurrence of pain. It is on the web and was in Neurosurgery Feb 2000. Does anyone have newer statistics?I have an appt with the surgeon in Nov. That gives me time to think about what I want to do. I am considering another MVD but like all of us, I would like to know my chances of success and also my risks specifically of AD. I had a lot of numbness with my first MVD so I am concerned that more numbness may damage the nerve.

Here is the website:
http://www.ncbi.nlm.nih.gov/pubmed/10690724

And the abstract of the article.

Recurrent trigeminal neuralgia attributable to veins after microvascular decompression.
Lee SH, Levy EI, Scarrow AM, Kassam A, Jannetta PJ.
Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA.

Abstract
OBJECTIVE: To demonstrate the cause of and optimal treatment for recurrent trigeminal neuralgia (TN) in cases where veins were observed to be the offending vessels during the initial microvascular decompression (MVD) procedure.
METHODS: An electronic search of patient records from 1988 to 1998 revealed that 393 patients were treated with MVD for TN caused by veins. The pain recurred in 122 patients (31.0%). Thirty-two (26.2%) of these patients underwent reoperations. Clinical presentations, recurrence intervals, surgical findings, and clinical outcomes were analyzed.
RESULTS: Analysis of 32 consecutive cases of recurrent TN initially attributable to veins revealed a female predominance (female/male = 26:5), with one female patient exhibiting bilateral TN caused by venous compression. Patient ages ranged from 15 to 80 years, with a prevalence in the seventh decade. The V2 distribution of the face was involved more frequently than other divisions. For 24 patients (75%), recurrence occurred within 1 year after the initial operation. At the time of the second MVD procedure, development of new veins around the nerve root was observed in 28 cases (87.5%). After successful subsequent MVD procedures, the pain was improved in 81.3% of the cases.
CONCLUSION: The recurrence rate for TN attributable to veins is high. If pain recurs, it is likely to recur within 1 year after the initial operation. The most common cause of recurrence is the development and regrowth of new veins. Even fine new veins may cause pain recurrence; these veins may be located beneath the felt near the root entry zone or distally, near Meckel's cave. Because of the variable locations of vein recurrence, every effort must be made to identify recollateralized veins. Given the high rate of pain relief after a second operation, MVD remains the optimal treatment for the recurrence of TN attributable to vein regrowth.
PMID: 10690724 [PubMed - indexed for MEDLINE]

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Permalink Reply by Liz K. on September 8, 2010 at 4:36pm

Pat,
Hindsight is 20/20. If we only knew what to do. I saw a new neuro today and I am scheduled for a MRI and a MRA next Wed. If I have another compression, then I will opt for a repeat MVD. I had a compression before but it wasn't seen on the MRI. Each of us tend to lean toward the treatment which was successful. And if we have a bad outcome, then of course we don't recommend that particular treatment. I'm sure if my MVD surgery had been awful and I didn't get full relief, then I would not think about it again. But my surgery was easy and I did get a lot of relief but I was never totally free of pain. I am sorry you are having so much pain.
Liz

Pat Akerberg said:

Thanks for explaining your current symptoms, Liz. Now I better understand your dilemma. Fortunately it doesn't sound like you're dealing with nerve damage and neuropathic pain. Unfortunately you're back at dealing with TN pain and looking into what to do about it. Maybe at a minimum one of the next steps is an MRI to determine if there are any compressions. In my case the MRI didn't show any but when the surgeon went in there was an artery and a vein. If I had a "do-over", I would have done my best to manage on medication as long as I could to have time to more fully research all of my options and would have interviewed several neurosurgeons. Hindsight is always 20/20. I've seen some research articles that talk about certain veins that cannot be cut or situations where they or an artery actually go through the nerve so they can't be cut (or padded). It's complex, just like each one of us in unique and no two situations are alike. Wishing you the best as you research options.

Pat

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Permalink Reply by Beth Lipovsky on October 14, 2010 at 7:48am

Hi Liz -

Can you describe your numbness after your MVD surgery? Was it immediate or did it come on several days later? Was it painful, like pins and needles, or just numb? And how many months did it last for? After reading through all these posts, it sounds like probably 6 to 9 months, but wasn't sure if I was inferring the duraction correctly. Thanks! Good luck with all the decisions you are sorting out. Wish I could offer some help, but I'm afraid I don't have much to add to the discussion at this point. Our current situation is 3 weeks post MVD with severe pain and complete numbness and getting worried about what the future holds for us now..... Best wishes to you!

Regards,
-Beth

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Permalink Reply by Liz K. on October 21, 2010 at 10:30pm

Hi Beth,
I had immediate numbness and it lasted for about 8 mths??. It was a long time. The back of my head near the cut lasted almost a year.
I am sorry you are having such severe pain. My pain was reduced right after the surgery but I didn't have full pain relief but I was much better. And I continued to get better for about 6 mths. But it has been about a yr and a half and my pain is returning. But it still isn't as bad as it was pre-surgey.
I hope your pain will get better.
Liz

Beth Lipovsky said:

Hi Liz -

Can you describe your numbness after your MVD surgery? Was it immediate or did it come on several days later? Was it painful, like pins and needles, or just numb? And how many months did it last for? After reading through all these posts, it sounds like probably 6 to 9 months, but wasn't sure if I was inferring the duraction correctly. Thanks! Good luck with all the decisions you are sorting out. Wish I could offer some help, but I'm afraid I don't have much to add to the discussion at this point. Our current situation is 3 weeks post MVD with severe pain and complete numbness and getting worried about what the future holds for us now..... Best wishes to you!

Regards,
-Beth

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Permalink Reply by Beth Lipovsky on October 22, 2010 at 8:13am

Thanks for sharing, Liz! I'm sorry you had to endure the numbness and pain for so long. I do appreciate the information though.... it is a big source of hope for us right now! We have been so scared lately. Just hearing that it may be a slow recover, but that there IS still hope, is great. Just patience, patience, patience... more holistic healing... more praying. We sure learn how to be more aware of the greater powers around us during moments (I say that lightly) of weakness like this. Appreciate the insight. Best wishes to you as you figure out step #2!

-Beth