What Does One Do When Trigeminal Neuralgia Comes Back?

After Various Procedures, Trigeminal Neuralgia can come back. Study discusses how they handled it.

Stereotact Funct Neurosurg. 2010 Apr 1;88(3):156-162. [Epub ahead of print]
Effect of Various Surgical Modalities in Recurrent or Persistent Trigeminal Neuralgia.
Han I, Shin D, Chang J, Kim K, Chang J, Huh R, Chung  abstract here

Unfortunately, do not have access to the whole article , but the conclusions were

Conclusion: In this study the authors demonstrate that

• percutaneous rhizotomy is recommended for most patients with recurrent pain after MVD[microvascular decompression surgery]
• 
• see here for more info on rhizotomy:

http://www.umanitoba.ca/cranial_nerves/trigeminal_neuralgia/manuscript/rhizotomies.html#types

• MVD [Microvascular decompression surgery] can be effective in patients with a history of failed percutaneous procedures. Radiosurgery can be utilized to treat those that have not responded to other surgical modalities

See here for more on decompression surgery:

http://www.umanitoba.ca/cranial_nerves/trigeminal_neuralgia/manuscript/mvd.html

Addendums:

1) Recent poster presentation at IASP 2010 determined that most TN needed a combination of carbemazepine (Tegretol) and dilantin to capture control.

2) Recently, Botox injections have been found to give long lasting results if there is a trigger zone:
Confirmed – Botox works for Trigeminal Neuralgia – Given Into Trigger Zone

I have gotten long lasting relief injecting injecting semineurolytic to neurolytic strength local anesthetic in trigeminal nerve roots:
Alternate Approaches to Post-Herpetic Neuralgia (PHN)