Although we use Teflon implant to mobilize offending arteries and veins away from the nerve. There are occasional and potentially controversial circumstances, where the Teflon itself could be the cause of recurrent pain after a microvascular decompression surgery. In these situations, this diagnosis could be consistent with a Teflon granuloma. In other words, the inflammation caused by the piece of Teflon can cause trigeminal neuralgia. I'm going to show you the case of one of my patients. A 52 year old female who underwent an MVD three years ago in another institution and returned with recurrent trigeminal neuralgia. Her pain was very much refractory. You can see post operative changes in the area of the right trigeminal nerve related to the previous surgery. I offered her a right sided retromastoid craniotomy you can see the area of the scarring, you can see the cerebellum, the dural tack of pages along the dural sinuses. You can see how scarred the cerebellum is to the area of the petrous spine and the tentorium. We went ahead and used microdissection to be able to access the trigeminal nerve. In this situation, you can see the nerve at the depth of our dissection cavity and it's covered with really thick amount of Teflon. And that's one of the reasons we should avoid using excessive amount of Teflon to prevent this situation. So here's the nerve again, here you see the Teflon very much embedded within the nerve itself and we'll continue to mobilize the Teflon gently without injuring the nerve. You can see how the nerve is discolored and looks somewhat reddish. Micro dissection is used to cut pieces of Teflon. Here's looking underneath the nerve to make sure there is no offending vessel missed and looking above, and again, no other arteriovenous branches were noted to compress this nerve but the patient benefited with significant relief of her pain by just mobilizing and removing the Teflon. And therefore, there are rare circumstances that I believe re-exploration and removal of the Teflon could be beneficial in providing relief of pain. Thank you.
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