Shredded vs. pledget teflon in microvascular decompression for trigeminal neuralgia: a retrospective comparative study.

OBJECTIVE

Trigeminal neuralgia (TN) is a debilitating craniofacial pain disorder that often necessitates surgical intervention when medical therapy fails. This study evaluates the impact of two Teflon implantation techniques - pledget interposition and shredded Teflon - on clinical outcomes following microvascular decompression (MVD).

METHODS

A retrospective analysis was conducted on 121 patients with classical trigeminal neuralgia (TN) who underwent microvascular decompression (MVD) between 2001 and 2020. Patients were grouped based on the Teflon technique used: pledget interposition (n = 55) or shredded Teflon (n = 66). Outcomes were assessed using the Barrow Neurological Institute (BNI) pain scale, Modified Rankin Scale (mRS), and postoperative MRI. Statistical comparisons included Fisher's exact test, chi-square test, and t-tests.

RESULTS

Shredded Teflon was associated with significantly lower recurrence (4.54% vs. 16.36%) and complication rates (9.09% vs. 14.55%) compared to pledget interposition. Reoperation was required in 12.72% of pledget cases, primarily due to implant displacement and arachnoid adhesions; no reoperations were needed in the shredded group. MRI-confirmed recurrent neurovascular compression correlated with clinical recurrence (p = 0.033). Patient satisfaction was significantly higher in the shredded group (87.87% vs. 69.09%, p = 0.001).

CONCLUSION

MVD using shredded Teflon yields superior long-term outcomes with fewer complications and recurrences compared to pledget interposition. Avoiding direct nerve contact and minimizing implant volume may reduce inflammatory risks. Postoperative MRI is crucial for detecting recurrence and guiding subsequent interventions.