Treatment of recurrent trigeminal neuralgia due to Teflon granuloma

The Journal of Headache and Pain

Original

Joachim K. Krauss¹  Hans-Holger Capelle¹  Christoph A. Tschan²  Almuth Brandis³ 

[1] Department of Neurosurgery, Hannover Medical School, MHH, Carl-Neuberg-Str. 1, 30625, Hannover, Germany;Department of Neurosurgery, Hannover Medical School, MHH, Carl-Neuberg-Str. 1, 30625, Hannover, Germany;Department of Neurosurgery, University Hospital Mainz, Mainz, Germany;Institute of Pathology, Hannover Medical School, 30625, Hannover, Germany;

关键词: Trigeminal neuralgia;    Facial pain;    Microvascular decompression;    Teflon granuloma;   

DOI  :  10.1007/s10194-010-0213-4

 received in 2010-02-22, accepted in 2010-04-06,  发布年份 2010

来源: Springer

【 摘 要 】

Recurrent trigeminal neuralgia after microvascular decompression (MVD) may be due to insufficient decompression, dislocation of the implant to pad the neurovascular contact, or the development of granuloma. Here, we report on our experience with Teflon granuloma including its treatment and histopathological examination. In a series of 200 patients with trigeminal neuralgia MVD was performed with Teflon felt according to Jannetta’s technique. In three patients with recurrent facial pain Teflon granuloma was found to be the cause for recurrence. In each instance, the granuloma was removed for histopathological examination. Mean age at the first procedure was 62.3 years and at the second procedure 66.3 years. Recurrence of pain occurred between 1 and 8.5 years after the first procedure. MRI scans demonstrated local gadolineum enhancement in the cerebellopontine angle, and CT scans showed local calcification. Intraoperatively dense fibrous tissue was found at the site of the Teflon granuloma. Histopathological examination revealed foreign body granuloma with multinuclear giant cells, collagen-rich hyalinized scar tissue, focal hemosiderin depositions, and microcalcifications. The Teflon granuloma was completely removed, and a new Teflon felt was used for re-decompression. Patients were free of pain after the second procedure at a mean of 40.3 months of follow-up. Teflon granuloma is a rare cause for recurrent facial pain after MVD. Small bleeding into the Teflon felt at surgery might trigger its development. A feasible treatment option is surgical re-exploration, nerve preserving removal of the granuloma, and repeat MVD.

【 授权许可】

Unknown   
© Springer-Verlag 2010