Teflon granuloma after microvascular decompression for trigeminal neuralgia.

BACKGROUND

Our purpose was to research the factors that may induce Teflon granuloma in trigeminal neuralgia patients who have undergone microvascular decompression (MVD) procedures, to propose methods for the early diagnosis of Teflon granuloma, and provide suggestions for reducing this complication.

METHODS

From 1985 to 1996, 89 trigeminal neuralgia patients underwent MVD with Teflon felt to separate the offending vessels and the trigeminal nerve. Ten patients had secondary explorations for recurrent symptoms. Five patients developed recurrent facial pain associated with facial numbness within a certain period after the first operation. We reviewed the onset and site of the initial symptoms, the duration of the symptoms, the operative findings and methods, and the results of the operations. In the reoperative patients, we analyzed the initial and secondary symptoms after the first operation, and the time to relapse. We compared the operative findings and methods in these operations.

RESULTS

The operative findings in the 10 patients with recurrence were Teflon granuloma in five patients, arterial loop compression in three patients, venous compression in one patient, and negative exploration in one patient. The Teflon granuloma patients all complained of facial numbness after the first MVD operation. The incidence of Teflon granuloma after MVD was 5.6% (5/89).

CONCLUSION

The Teflon felt used in the MVD procedure can produce complications. It is not absolutely inert when used in MVD procedures. When it contacts the tentorium and/or dura, an inflammatory giant-cell foreign body reaction can be induced. In the future, we should search for other implants to replace the Teflon felt. However, until new materials are found, we suggest that the Teflon felt be kept away from the tentorium and dura and placed completely within the CSF cisterna. We can diagnose Teflon granuloma early with enhanced CT and/or MRI, especially in patients with new facial numbness symptoms after Teflon MVD procedures. The results of reexploration of Teflon granulomas are more satisfactory than a negative exploration or venous compression. We may be able to decrease the incidence of Teflon granuloma. We should be more aggressive in performing reexploration in these recurrent patients.