Surgical treatment of trigeminal neuralgia

Montano et al. What is the best treatment of drug-resistant trigeminal neuralgia in patients affected by multiple sclerosis? A literature analysis of surgical procedures. Clin Neurol Neurosurg. 2012 Jul 26.

OBJECTIVE: Drug-resistant trigeminal neuralgia (TN) can complicate the clinical course of MS. Various surgical procedures have been reported for the treatment of this condition, but there is no agreement on the best management of these MSers. To our knowledge, there is no critical literature analysis focusing on this particular topic. The aim of this study was to evaluate the clinical outcome of different surgical procedures utilized for drug-resistant TN in MSers.

METHODS: They reviewed the literature about the studies reporting on surgical treatment of drug-resistant TN in MSers. Case reports and case series less than 4 MSers were excluded from the analysis. Nineteen studies were selected for the statistical analysis. To reduce the variability of the data, the selected studies were evaluated for the following outcome parameters: acute pain relief rate (APR), rate of recurrence (RR), pain free at follow-up rate (PF at FU) and complication rate (CR). For the statistical analysis, chi-square statistic, using the Fisher’s exact test was utilized.

RESULTS: There was no procedure statistically superior in terms of APR rate in MSers following the surgical treatment of TN. The highest RR was observed for percutaneous balloon compression (PBC) (60.2±14.4%). This result was statistically significant when compared to gamma knife surgery (GKS) (p=0.0129) and microvascular decompression (MVD) (p=0.0281). MVD together with percutaneous radiofrequency rhizothomy (PRR) was associated with a statistically better PF at FU rate (56.5±16.8% and 73.5±14.2%, respectively). However PBC and MVD showed statistical significant minor CR compared to other techniques (no complications and 18.7±17.4%, respectively).

CONCLUSION: This study shows no differences in the short term results among different procedures for TN in MSers. Each technique demonstrate advantages and limits in terms of long term pain, recurrence rate and complication rate. Each MSer should be accurately informed on pros and cons of each procedure in order to be involved in the most appropriate choice.

“Trigeminal neuralgia can be a major management problem in MS; if you have had it you will know what I mean. It looks as if percutaneous balloon compression is a no-no. As you can see  the results are quite variable; I suggest you as to see the results of the surgical unit you have been referred to before making a decision about what procedure to have. This is a typical example why surgeons should publish their outcomes so that MSers or clients can make informed decisions about what treatment to have!”

“Please note that most episodes of trigeminal neuralgia settle with medical therapy; typically carbamazepine or oxcarbazepine. Therefore surgical intervention is only used as a back-up treatment option.”

Additional reading: trigeminal neuralgia

This is a very similar post but ballon compression was better research-surgery-for-facial-pain.html
Past posts on this aspect

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