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Long-term follow-up of multimodality treatment for multiple sclerosis-related trigeminal neuralgia

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Abstract

Background

The treatment for multiple sclerosis-related trigeminal neuralgia (MS-TN) is less efficacious and associated with higher recurrence rates than classical TN. No consensus has been reached in the literature on the choice procedure for MS-TN patients. The aim of this study was to assess the incidence and surgical outcomes of medically refractory MS-TN.

Methods

Patient records were retrospectively reviewed for all Manitobans undergoing first procedure for medically refractory MS-TN between 2000 and 2014. Subsequent procedures were then recorded and analyzed in this subgroup of patients. The primary outcome measure was time to treatment failure.

Results

The incidence of medically refractory MS-TN was 1.2/million/year. Twenty-one patients with 26 surgically treated sides underwent first rhizotomy including 13 GammaKnife and 13 percutaneous rhizotomies comprised of ten glycerol injections and three balloon compressions. Subsequent procedures were required on 23 sides (88%), including 24 GammaKnife, 19 glycerol injections, 25 balloon compressions, two microvascular decompressions, and four open partial surgical rhizotomies with a total of 99 surgeries on 26 sides (range, 1–12 each).

Conclusions

The majority of MS-TN patients become medically refractory and require multiple repeat surgical procedures. MS-TN procedures were associated with high rates of pain recurrence and our data suggests reoperation within 1 year is often necessary. Optimal management strategy in this patient population remains to be determined. Patients need to be counseled on managing expectations as treatments commonly afford only temporary relief.

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Funding

No funding was received for this research.

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Authors and Affiliations

  1. Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada

    Sandeep Krishnan, Mark Bigder & Anthony M. Kaufmann

  2. Health Sciences Centre, GB129-820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada

    Sandeep Krishnan, Mark Bigder & Anthony M. Kaufmann

Authors
  1. Sandeep Krishnan
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  2. Mark Bigder
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  3. Anthony M. Kaufmann
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Corresponding author

Correspondence to Mark Bigder.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Conferences

1. Platform Speaker at University of Manitoba Department of Surgery Annual Research Day on January 13, 2016.

2. Platform Speaker at Canadian Neurological Sciences Federation 51st Congress in Quebec City on June 24, 2016.

3. Platform Speaker at University of Manitoba, UGME Research Symposium on August 18, 2016

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Krishnan, S., Bigder, M. & Kaufmann, A.M. Long-term follow-up of multimodality treatment for multiple sclerosis-related trigeminal neuralgia. Acta Neurochir 160, 135–144 (2018). https://doi.org/10.1007/s00701-017-3383-x

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  • DOI: https://doi.org/10.1007/s00701-017-3383-x

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