Teflon granuloma after microvascular decompression for trigeminal neuralgia

Jyi Feng Chen, Shih Tseng Lee, Tai Ngar Lui, Yi Shian Yeh, Tzu Yung Chen, Wen Ching Tzaan

Research output: Contribution to journalArticle

65 Citations (Scopus)

Abstract

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. Copyright (C) 2000 Elsevier Science Inc.

Original languageEnglish
Pages (from-to)281-287
Number of pages7
JournalSurgical Neurology
Volume53
Issue number3
DOIs
Publication statusPublished - Mar 2000
Externally publishedYes

Fingerprint

Microvascular Decompression Surgery
Trigeminal Neuralgia
Polytetrafluoroethylene
Granuloma
Hypesthesia
Foreign-Body Reaction
Recurrence
Facial Pain
Trigeminal Nerve
Incidence
Giant Cells

Keywords

  • Microvascular decompression
  • Recurrent trigeminal neuralgia
  • Teflon granuloma

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Chen, J. F., Lee, S. T., Lui, T. N., Yeh, Y. S., Chen, T. Y., & Tzaan, W. C. (2000). Teflon granuloma after microvascular decompression for trigeminal neuralgia. Surgical Neurology, 53(3), 281-287. https://doi.org/10.1016/S0090-3019(00)00169-5

Teflon granuloma after microvascular decompression for trigeminal neuralgia. / Chen, Jyi Feng; Lee, Shih Tseng; Lui, Tai Ngar; Yeh, Yi Shian; Chen, Tzu Yung; Tzaan, Wen Ching.

In: Surgical Neurology, Vol. 53, No. 3, 03.2000, p. 281-287.

Research output: Contribution to journalArticle

Chen, JF, Lee, ST, Lui, TN, Yeh, YS, Chen, TY & Tzaan, WC 2000, 'Teflon granuloma after microvascular decompression for trigeminal neuralgia', Surgical Neurology, vol. 53, no. 3, pp. 281-287. https://doi.org/10.1016/S0090-3019(00)00169-5
Chen, Jyi Feng ; Lee, Shih Tseng ; Lui, Tai Ngar ; Yeh, Yi Shian ; Chen, Tzu Yung ; Tzaan, Wen Ching. / Teflon granuloma after microvascular decompression for trigeminal neuralgia. In: Surgical Neurology. 2000 ; Vol. 53, No. 3. pp. 281-287.
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AU - Chen, Tzu Yung

AU - Tzaan, Wen Ching

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N2 - 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. Copyright (C) 2000 Elsevier Science Inc.

AB - 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. Copyright (C) 2000 Elsevier Science Inc.

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