Surgical outcomes of trigeminal neuralgia in patients with multiple sclerosis.
BACKGROUND
Trigeminal neuralgia (TN) is relatively frequent in multiple sclerosis (MS) patients and can be extremely disabling. Surgical interventions are less effective for the treatment of MS-related TN compared with classic TN, and higher recurrence rates are observed.


OBJECTIVE
To evaluate initial pain-free response (IPFR), duration of pain-free intervals (PFIs), and factors predictive of outcome in different surgical modalities used to treat MS-related TN.


METHODS
A total of 96 MS patients underwent 277 procedures (range, 1-11 procedures per patient) to treat TN at our institution from 1995 to 2011. Of these, 89 percutaneous retrogasserian glycerol rhizotomies, 82 balloon compressions, 52 stereotactic radiosurgeries, 28 peripheral neurectomies, 15 percutaneous radiofrequency rhizotomies, and 10 microvascular decompressions were performed as upfront or repeat treatments.


RESULTS
Bilateral pain was observed in 10% of patients during the course of disease. During the follow-up period (median, 5.7 years), recurrence of symptoms was seen in 66% of patients, and 181 procedures were performed for symptom recurrence. As an initial procedure, balloon compression had the highest IPFR (95%; P = .006) and median PFI (28 months; P = .05), followed by percutaneous retrogasserian glycerol rhizotomy (IPFR, 74%, P = .04; median PFI, 9 months; P = .05). In general, repeat procedures had lower effectiveness compared with initial procedures, with no statistically significant difference seen across the various treatment modalities.


CONCLUSIONS
Treatment failure occurs in most of the MS-related TN patients independently of the type of treatment. However, balloon compression had the highest rate of IPFR and PFI compared with other modalities in the initial treatment of MS-related TN.
*Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, ‡Department of Neurosurgery, §Neurological Institute, and #Department of Quantitative Health Science, Cleveland Clinic, Cleveland, Ohio; ¶Department of Neurosurgery, Hopkins Medical Institute, Baltimore, Maryland.
Alireza
A
Mohammad-Mohammadi
Pablo F
PF
Recinos
Joung H
JH
Lee
Paul
P
Elson
Gene H
GH
Barnett
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications*; D059408:Pain Management / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000209:etiology* / Q000601:surgery*; D055815:Young Adult