Teflon™ or Ivalon®: a scoping review of implants used in microvascular decompression for trigeminal neuralgia

Background Trigeminal neuralgia (TN) is characterized by jolts of pain along the distribution of the trigeminal nerve. If patients fail conservative management, microvascular decompression (MVD) is the next step in treatment. MVD is largely done by placing implant pads between the nerve and compressing vessels. We conducted a literature review to assess effectiveness and safety of Teflon (TM) and Ivalon (R) sponges for treatment of TN with MVD. Methods In January 2019, PubMed was searched for manuscripts published in English using permutations of Microvascular decompression, Teflon, Ivalon, Granuloma, Polytetrafluoroethylene, Trigeminal Neuralgia, and Exploration. Success and relapse rates, causes of relapse, and complication rates were analyzed. We analyzed for relationships with ANCOVA at an alpha threshold of .05. Results Thirty-six studies representing 4273 patients fit inclusion criteria. Twenty-five dealt with initial MVD, 12 with re-do MVD. Initial MVD initial success rates were 85% in patients receiving Teflon (TM) (57-100%*) and 91% in patients receiving Ivalon (R) (79-100%*). Recurrence rates were 12% in Teflon (TM) patients (0*-30%) and 9.1% in Ivalon (R) patients (0*-19%). In patients with relapses, implants were the cause in 49% of Teflon (TM) patients (0*-100%*) and 50% of Ivalon (R) patients (0*-100%*). Complication rates for patients receiving Teflon (TM) were 12% (0*-34%) and 19% for patients receiving Ivalon (R) (0*-40%). Conclusion Teflon (TM) and Ivalon (R) are two materials used in MVD for TN. It is an effective treatment with long-term symptom relief and recurrence rates of 1-5% each year. Ivalon (R) has been used less than Teflon (TM) though is associated with similar success rates and similar complication rates.