Posterior fossa reexploration for persistent or recurrent XXXX or hemifacial @entity2473 : surgical findings and therapeutic implications.

@entity1 @entity4832 @entity4254 @entity2850 @entity2473 @entity531
OBJECTIVE: To evaluate the surgical findings and subsequent therapeutic implications of posterior fossa reexploration for persistent or recurrent @entity4254 ( @entity4254 ) or hemifacial @entity2473 (HFS) after failed microvascular decompression (MVD). METHODS: Between December 1975 and October 1996, the senior author performed 31 reexplorations for failure or recurrence after MVD: 23 for @entity4254 and 8 for HFS. Records were analyzed retrospectively for evidence of @entity2850 in primary and secondary operations, other pertinent intraoperative findings, intraoperative therapeutic interventions, and postoperative results and complications. RESULTS: The previously placed @entity4832 foam (Ivalon sponge; Unipoint Industries, High Point, NC) or Teflon implant (Teflon felt; CR Bard, Inc., Bard Implants Division, Billerica, MA) was found to be in good position in 100% of the @entity1 (31 of 31 @entity1 ). New @entity2850 from an arterial source was found in three @entity1 during posterior fossa reexploration: one with @entity4254 and two with HFS. New @entity2850 from a venous source was observed in one @entity1 with HFS. A scarred Ivalon sponge or Teflon implant with apparent mass effect on the nerve root was identified in seven reexplorations. One bony source of compression was seen. No new compressive elements or other sources of root irritation were appreciated in 61% of reexplorations. Partial sensory trigeminal rhizotomy was performed in 83% of reexplorations for persistent or recurrent @entity4254 . Of eight @entity1 undergoing reexploration for persistent or recurrent HFS, six sustained complications. CONCLUSION: Recurrent @entity2850 was seldom identified during posterior fossa reexploration for failed MVD in @entity1 with persistent or recurrent @entity4254 or HFS. The previously placed Ivalon sponge or Teflon implant was consistently found to be in good position. Partial sensory trigeminal rhizotomy is an often effective alternative in cases of recurrent @entity531 is not identified. However, because of the relatively high incidence of complications associated with reexploration, we recommend other ablative or medical treatments for most @entity1 after failed MVD for @entity4254 or HFS.
