Abstract
Background: The optimal treatment for medically refractory trigeminal neuralgia in multiple sclerosis (MS-TN) patients is unknown. Objective: To compare treatment outcomes between stereotactic radiosurgery (SRS) and radiofrequency ablation (RFA). Methods: We performed a retrospective study of MS-TN patients treated with SRS or RFA between 2002 and 2019. Outcomes included degree of pain relief, pain recurrence, and sensory changes, segregated based on initial treatment, final treatment following retreatment with the same modality, and crossover patients. Results: Sixty surgical cases for 42 MS-TN patients were reviewed. Initial pain freedom outcomes and rates of retreatment were similar (SRS: 30%; RFA: 42%). RFA resulted in faster onset of pain freedom (RFA: <1 week; SRS: 15 weeks; p < 0.001). SRS patients with pain relief had longer intervals to pain recurrence at 2 years (p = 0.044). Final treatment outcomes favored RFA for pain freedom/off-medication outcomes (RFA: 44%; SRS: 11%; p = 0.031), though RFA resulted in more paresthesia (RFA: 81%; SRS: 39%; p = 0.012). Both provided at least 80% of adequate pain relief. Crossover patients did not have improved pain relief. Conclusions: SRS and RFA are both valid surgical options for MS-TN. Discussion with providers will need to balance patient preference with their unique treatment characteristics.
References
1.
Sweet
WH
. The treatment of trigeminal neuralgia (tic douloureux)
. N Engl J Med
. 1986
Jul
;315
(3
):174
–7
.
[PubMed]
0028-47932.
Wang
DD
, Raygor
KP
, Cage
TA
, Ward
MM
, Westcott
S
, Barbaro
NM
, et al. Prospective comparison of long-term pain relief rates after first-time microvascular decompression and stereotactic radiosurgery for trigeminal neuralgia
. J Neurosurg
. 2018
Jan
;128
(1
):68
–77
.
[PubMed]
0022-30853.
Broggi
G
, Ferroli
P
, Franzini
A
, Nazzi
V
, Farina
L
, La Mantia
L
, et al. Operative findings and outcomes of microvascular decompression for trigeminal neuralgia in 35 patients affected by multiple sclerosis
. Neurosurgery
. 2004
Oct
;55
(4
):830
–8
.
[PubMed]
0148-396X4.
Love
S
, Gradidge
T
, Coakham
HB
. Trigeminal neuralgia due to multiple sclerosis: ultrastructural findings in trigeminal rhizotomy specimens
. Neuropathol Appl Neurobiol
. 2001
Jun
;27
(3
):238
–44
.
[PubMed]
0305-18465.
Lazar
ML
, Kirkpatrick
JB
. Trigeminal neuralgia and multiple sclerosis: demonstration of the plaque in an operative case
. Neurosurgery
. 1979
Dec
;5
(6
):711
–7
.
[PubMed]
0148-396X6.
Broggi
G
, Ferroli
P
, Franzini
A
, Pluderi
M
, La Mantia
L
, Milanese
C
. Role of microvascular decompression in trigeminal neuralgia and multiple sclerosis
. [letter]
. Lancet
. 1999
Nov
;354
(9193
):1878
–9
.
[PubMed]
0140-67367.
Hooge
JP
, Redekop
WK
. Trigeminal neuralgia in multiple sclerosis
. Neurology
. 1995
Jul
;45
(7
):1294
–6
.
[PubMed]
0028-38788.
Rushton
JG
, Olafson
RA
. Trigeminal neuralgia associated with multiple sclerosis. A case report
. Arch Neurol
. 1965
Oct
;13
(4
):383
–6
.
[PubMed]
0003-99429.
Cheng
JS
, Sanchez-Mejia
RO
, Limbo
M
, Ward
MM
, Barbaro
NM
. Management of medically refractory trigeminal neuralgia in patients with multiple sclerosis
. Neurosurg Focus
. 2005
May
;18
(5
):e13
.
[PubMed]
1092-068410.
Mohammad-Mohammadi
A
, Recinos
PF
, Lee
JH
, Elson
P
, Barnett
GH
. Surgical outcomes of trigeminal neuralgia in patients with multiple sclerosis
. Neurosurgery
. 2013
Dec
;73
(6
):941
–50
.
[PubMed]
0148-396X11.
Zakrzewska
JM
, Wu
J
, Brathwaite
TS
. A Systematic Review of the Management of Trigeminal Neuralgia in Patients with Multiple Sclerosis
. World Neurosurg
. 2018
Mar
;111
:291
–306
.
[PubMed]
1878-875012.
Montano
N
, Papacci
F
, Cioni
B
, Di Bonaventura
R
, Meglio
M
. Percutaneous balloon compression for the treatment of trigeminal neuralgia in patients with multiple sclerosis. Analysis of the potentially prognostic factors
. Acta Neurochir (Wien)
. 2012
May
;154
(5
):779
–83
.
[PubMed]
0001-626813.
Holland
MT
, Teferi
N
, Noeller
J
, Swenson
A
, Smith
M
, Buatti
J
, et al. Stereotactic radio surgery and radio frequency rhizotomy for trigeminal neuralgia in multiple sclerosis: A single institution experience
. Clin Neurol Neurosurg
. 2017
Nov
;162
:80
–4
.
[PubMed]
0303-846714.
Rogers
CL
, Shetter
AG
, Ponce
FA
, Fiedler
JA
, Smith
KA
, Speiser
BL
. Gamma knife radiosurgery for trigeminal neuralgia associated with multiple sclerosis
. J Neurosurg
. 2002
Dec
;97
(5
Suppl
):529
–32
.
[PubMed]
0022-308515.
Weller
M
, Marshall
K
, Lovato
JF
, Bourland
JD
, deGuzman
AF
, Munley
MT
, et al. Single-institution retrospective series of gamma knife radiosurgery in the treatment of multiple sclerosis-related trigeminal neuralgia: factors that predict efficacy
. Stereotact Funct Neurosurg
. 2014
;92
(1
):53
–8
.
[PubMed]
1011-612516.
Conti
A
, Pontoriero
A
, Iatì
G
, Esposito
F
, Siniscalchi
EN
, Crimi
S
, et al. Frameless Stereotactic Radiosurgery for Treatment of Multiple Sclerosis-Related Trigeminal Neuralgia
. World Neurosurg
. 2017
Jul
;103
:702
–12
.
[PubMed]
1878-875017.
Tuleasca
C
, Carron
R
, Resseguier
N
, Donnet
A
, Roussel
P
, Gaudart
J
, et al. Multiple sclerosis-related trigeminal neuralgia: a prospective series of 43 patients treated with gamma knife surgery with more than one year of follow-up
. Stereotact Funct Neurosurg
. 2014
;92
(4
):203
–10
.
[PubMed]
1011-612518.
Zorro
O
, Lobato-Polo
J
, Kano
H
, Flickinger
JC
, Lunsford
LD
, Kondziolka
D
. Gamma knife radiosurgery for multiple sclerosis-related trigeminal neuralgia
. Neurology
. 2009
Oct
;73
(14
):1149
–54
.
[PubMed]
0028-387819.
Mathieu
D
, Effendi
K
, Blanchard
J
, Séguin
M
. Comparative study of Gamma Knife surgery and percutaneous retrogasserian glycerol rhizotomy for trigeminal neuralgia in patients with multiple sclerosis
. J Neurosurg
. 2012
Dec
;117
(Special_Suppl
Suppl
):175
–80
.
[PubMed]
0022-308520.
Kanpolat
Y
, Berk
C
, Savas
A
, Bekar
A
. Percutaneous controlled radiofrequency rhizotomy in the management of patients with trigeminal neuralgia due to multiple sclerosis
. Acta Neurochir (Wien)
. 2000
;142
(6
):685
–9
.
[PubMed]
0001-626821.
Berk
C
, Constantoyannis
C
, Honey
CR
. The treatment of trigeminal neuralgia in patients with multiple sclerosis using percutaneous radiofrequency rhizotomy
. Can J Neurol Sci
. 2003
Aug
;30
(3
):220
–3
.
[PubMed]
0317-167122.
Bender
MT
, Pradilla
G
, Batra
S
, See
AP
, James
C
, Pardo
CA
, et al. Glycerol rhizotomy and radiofrequency thermocoagulation for trigeminal neuralgia in multiple sclerosis
. J Neurosurg
. 2013
Feb
;118
(2
):329
–36
.
[PubMed]
0022-308523.
Brisman
R
. Trigeminal neuralgia and multiple sclerosis
. Arch Neurol
. 1987
Apr
;44
(4
):379
–81
.
[PubMed]
0003-994224.
Fraioli
B
, Esposito
V
, Guidetti
B
, Cruccu
G
, Manfredi
M
. Treatment of trigeminal neuralgia by thermocoagulation, glycerolization, and percutaneous compression of the gasserian ganglion and/or retrogasserian rootlets: long-term results and therapeutic protocol
. Neurosurgery
. 1989
Feb
;24
(2
):239
–45
.
[PubMed]
0148-396X25.
Helis
CA
, McTyre
E
, Munley
MT
, Bourland
JD
, Lucas
JT
Jr, Cramer
CK
, et al. Gamma knife radiosurgery for multiple sclerosis-associated trigeminal neuralgia
. Neurosurgery
. 2019
Nov
;85
(5
):E933
–9
.
[PubMed]
0148-396X26.
Alpert
TE
, Chung
CT
, Mitchell
LT
, Hodge
CJ
, Montgomery
CT
, Bogart
JA
, et al. Gamma knife surgery for trigeminal neuralgia: improved initial response with two isocenters and increasing dose
. J Neurosurg
. 2005
Jan
;102
(Special_Supplement
Suppl
):185
–8
.
[PubMed]
0022-308527.
Brett
DC
, Ferguson
GG
, Ebers
GC
, Paty
DW
. Percutaneous trigeminal rhizotomy. Treatment of trigeminal neuralgia secondary to multiple sclerosis
. Arch Neurol
. 1982
Apr
;39
(4
):219
–21
.
[PubMed]
0003-994228.
Broggi
G
, Franzini
A
. Radiofrequency trigeminal rhizotomy in treatment of symptomatic non-neoplastic facial pain
. J Neurosurg
. 1982
Oct
;57
(4
):483
–6
.
[PubMed]
0022-3085© 2020 S. Karger AG, Basel
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