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Neurosurgery:
doi: 10.1227/NEU.0b013e31825e795b
Research-Human-Clinical Studies

Outcomes After Percutaneous Surgery for Patients With Multiple Sclerosis-Related Trigeminal Neuralgia

Mallory, Grant W. MD*; Atkinson, John L. MD*; Stien, Kathy J. RN*; Keegan, B. Mark MD; Pollock, Bruce E. MD*,§

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Abstract

BACKGROUND: Approximately 1% to 2% of patients with multiple sclerosis (MS) develop trigeminal neuralgia (TN). Percutaneous surgery is commonly performed in medically refractory cases.

OBJECTIVE: To analyze the pain outcomes and complications of patients with MS-related trigeminal neuralgia (MS-TN) having percutaneous surgery.

METHODS: Patients having balloon microcompression (BMC; n = 69) or glycerol rhizotomy (PRGR; n = 67) from 1997 to 2010 were reviewed retrospectively. Patients in the 2 groups were similar with regard to age, sex, pain location, and pain quality. Mean pain duration was longer in the PRGR group (54.6 vs 16 months; P < .001); more patients having BMC had prior surgery (87% vs 48%; P < .001). Outcomes were defined as excellent (no pain, no medications), good (no pain with medications), and poor. Median follow-up was 13 months (range, 0.25-132 months).

RESULTS: Ninety-five patients initially had excellent (n = 45, 33%) or good (n = 50, 37%) outcomes. Pain relief was maintained in 58% of patients at 3 months and 28% at 2 years. There was no difference in excellent/good outcomes between the surgical groups (hazard ratio = 0.73; P = .14). No correlation was noted between pain relief and new or increased facial numbness (hazard ratio = 0.78; P = .19). Forty-four BMC patients (64%) had additional surgery compared with 36 PRGR patients (54%; P = .19). Complications were more frequent after BMC (17.4% vs 3.0%; P < .01).

CONCLUSION: Percutaneous surgery for patients with MS-TN is less likely to provide pain relief than similar operations performed for patients with idiopathic TN. New trigeminal deficits did not correlate with better facial pain outcomes, supporting the concept that many patients with MS-TN have centrally mediated pain.

ABBREVIATIONS: BMC, balloon microcompression

MS, multiple sclerosis

MS-TN, multiple sclerosis-related trigeminal neuralgia

PRGR, percutaneous glycerol rhizotomy

RFL, radiofrequency ablation

TN, trigeminal neuralgia

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