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        "titulo" => "Management of recurrent trigeminal neuralgia after failed microvascular decompression"
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            0 => "Neuralgia del trig&#233;mino"
            1 => "Recidiva"
            2 => "Rizotom&#237;a sensitiva parcial"
            3 => "Reintervenci&#243;n"
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            1 => "Recurrence"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evaluar el manejo terap&#233;utico de los pacientes con recidiva del dolor trigeminal tras descompresi&#243;n microvascular&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Entre 1993 y 2002 se realizaron en nuestro servicio 60 exploraciones quir&#250;rgicas de la fosa posterior para tratamiento de la neuralgia del trig&#233;mino&#46; Se recogieron los datos de los pacientes que precisaron una nueva intervenci&#243;n quir&#250;rgica por recidiva del dolor trigeminal&#44; as&#237; como el tipo de intervenci&#243;n quir&#250;rgica realizada&#44; los hallazgos intraoperatorios en los casos de reexploraci&#243;n de la fosa posterior&#44; y el pron&#243;stico y las complicaciones que presentaron&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">En 18 pacientes se objetiv&#243; recidiva del dolor trigeminal y necesidad de un nuevo procedimiento quir&#250;rgico&#44; que consisti&#243; en una nueva exploraci&#243;n de la fosa posterior en 9 pacientes y ter-mocoagulaci&#243;n percut&#225;nea en 9 pacientes&#46; En 7 de las 9 reexploraciones &#40;77&#37;&#41; &#233;sta fue negativa&#44; realiz&#225;ndose rizotom&#237;a sensitiva parcial del tercio inferior de la ra&#237;z como procedimiento terap&#233;utico&#46; La mayor&#237;a de las termocoagulaciones &#40;5 de 9&#41; se realizaron en pacientes con edad avanzada o contraindicaci&#243;n m&#233;dica para la realizaci&#243;n de reexploraci&#243;n de fosa posterior&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La reexploraci&#243;n de fosa posterior es un m&#233;todo eficaz en el tratamiento de la recidiva de la neuralgia del trig&#233;mino tras descompresi&#243;n microvascular&#46; En el caso de exploraci&#243;n negativa&#44; la rizotom&#237;a sensitiva parcial es el m&#233;todo quir&#250;rgico de elecci&#243;n&#46;</p>"
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        "titulo" => "Summary"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To evaluate the surgical management of patients with trigeminal neuralgia after failed micro-vascular decompression&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Between 1993 and 2002&#44; exploration of the posterior fossa was performed in 60 patients with trigeminal neuralgia&#46; Records were analyzed retrospectively for those patients who needed another surgical procedure due to recurrence of pain&#44; describing which procedure was performed&#44; postoperative results and complications&#44; and also the intraope-rative findings when posterior fossa reexploration was realized&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Eighteen patients had trigeminal neuralgia recurrence requiring a new surgical intervention&#44; that consisted in a fossa posterior reexploration in nine patients and percutaneous radiofrequency termal rhi-zotomy in the other nine patients&#46; Among the repeat operations&#44; there was negative exploration in 7 patients &#40;77&#37;&#41;&#44; and a partial sensory rhizotomy was performed&#46; Most of thermocoagulations &#40;5&#47;9&#41; were performed in old patients or patients with anestesie contraindication for the fossa posterior reexploration&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Fossa posterior reexploration is an effective and safe surgical attitude in the treatment of recurrent trigeminal neuralgia after failed microvascular decompression&#46; Partial sensory rhizotomy is recom-mended when the reexploration is negative&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">Fern&#225;ndez-Carballal&#44; C&#59; Garc&#237;a-Salazar&#44; F&#46;&#59; P&#233;rez-Calvo&#44; J&#46;&#59; Garc&#237;a-Leal&#44; R&#46;&#59; Guti&#233;rrez&#44; F&#46;A&#46;&#59; Carrillo&#44; R&#46;&#58; Manejo de la recidiva de la neuralgia del trig&#233;mino tras descompresi&#243;n microvascular&#46; Neurocirug&#237;a 2004&#59; 15&#58;345&#8211;352&#46;</p>"
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Vol. 15. Núm. 4.
Páginas 345-351 (enero 2004)
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Vol. 15. Núm. 4.
Páginas 345-351 (enero 2004)
Manejo de la recidiva de la neuralgia del trigémino tras descompresión microvascular
Management of recurrent trigeminal neuralgia after failed microvascular decompression
Visitas
2741
C. Fernández-Carballal
, F. García-Salazar, J. Pérez-Calvo, R. García-Leal, F.A. Gutiérrez, R. Carrillo
Servicio de Neurocirugía. Hospital General Universitario Gregorio Marañón. Madrid
Este artículo ha recibido
Información del artículo
Resumen
Objetivos

Evaluar el manejo terapéutico de los pacientes con recidiva del dolor trigeminal tras descompresión microvascular.

Material y métodos

Entre 1993 y 2002 se realizaron en nuestro servicio 60 exploraciones quirúrgicas de la fosa posterior para tratamiento de la neuralgia del trigémino. Se recogieron los datos de los pacientes que precisaron una nueva intervención quirúrgica por recidiva del dolor trigeminal, así como el tipo de intervención quirúrgica realizada, los hallazgos intraoperatorios en los casos de reexploración de la fosa posterior, y el pronóstico y las complicaciones que presentaron.

Resultados

En 18 pacientes se objetivó recidiva del dolor trigeminal y necesidad de un nuevo procedimiento quirúrgico, que consistió en una nueva exploración de la fosa posterior en 9 pacientes y ter-mocoagulación percutánea en 9 pacientes. En 7 de las 9 reexploraciones (77%) ésta fue negativa, realizándose rizotomía sensitiva parcial del tercio inferior de la raíz como procedimiento terapéutico. La mayoría de las termocoagulaciones (5 de 9) se realizaron en pacientes con edad avanzada o contraindicación médica para la realización de reexploración de fosa posterior.

Conclusiones

La reexploración de fosa posterior es un método eficaz en el tratamiento de la recidiva de la neuralgia del trigémino tras descompresión microvascular. En el caso de exploración negativa, la rizotomía sensitiva parcial es el método quirúrgico de elección.

Palabras clave:
Neuralgia del trigémino
Recidiva
Rizotomía sensitiva parcial
Reintervención
Summary
Objective

To evaluate the surgical management of patients with trigeminal neuralgia after failed micro-vascular decompression.

Patients and methods

Between 1993 and 2002, exploration of the posterior fossa was performed in 60 patients with trigeminal neuralgia. Records were analyzed retrospectively for those patients who needed another surgical procedure due to recurrence of pain, describing which procedure was performed, postoperative results and complications, and also the intraope-rative findings when posterior fossa reexploration was realized.

Results

Eighteen patients had trigeminal neuralgia recurrence requiring a new surgical intervention, that consisted in a fossa posterior reexploration in nine patients and percutaneous radiofrequency termal rhi-zotomy in the other nine patients. Among the repeat operations, there was negative exploration in 7 patients (77%), and a partial sensory rhizotomy was performed. Most of thermocoagulations (5/9) were performed in old patients or patients with anestesie contraindication for the fossa posterior reexploration.

Conclusion

Fossa posterior reexploration is an effective and safe surgical attitude in the treatment of recurrent trigeminal neuralgia after failed microvascular decompression. Partial sensory rhizotomy is recom-mended when the reexploration is negative.

Key words:
Trigeminal neuralgia
Recurrence
Partial sensory rhizotomy
Reoperation

Artículo

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