Microvascular decompression in patients with trigeminal neuralgia and multiple sclerosis: results and analysis of possible prognostic factors

  • Nicola MontanoEmail author
  • Alessandro Rapisarda
  • Eleonora Ioannoni
  • Alessandro Olivi
Original article


We evaluated the results of microvascular decompression (MVD) in patients with trigeminal neuralgia (TN) and multiple sclerosis (MS) and we studied the role of several clinical and surgical factors as possible prognosticators of good outcome. To do this we performed, to our knowledge, the first literature review with a pooled analysis of data. A PubMed search of literature was conducted using the following terms: “microvascular decompression”, “trigeminal neuralgia” and “multiple sclerosis”. We screened 64 articles. Of them, 7 studies were eligible for this review. As outcome indicators we used the acute pain relief (APR) and the recurrence of pain. An APR was obtained in 71.42% and a recurrence of pain was reported in 26.00% of cases, respectively. At univariate analysis, younger age at surgery (p = 0.0419) and performing MVD as the first treatment (p = 0.0384) were associated to a higher probability of APR. The evidence of an MRI brainstem lesion related to the TN (p = 0.0482) was associated to a lower probability to obtain an APR after MVD. None of the evaluated factors affect the probability of recurrence of pain. At multivariate analysis the evidence of a brainstem MRI lesion related to the TN emerged as a negative prognosticator of APR (p = 0.0169). Our literature pooled analysis showed that MVD is effective in treating patients with MS-related TN. The evidence on MRI of a demyelinating plaque related to the TN is associated with a worse response to MVD. These data could suggest that MVD would be indicated mainly in patients without brainstem MRI lesions.


Magnetic resonance imaging Multiple sclerosis Microvascular decompression Prognosis Trigeminal neuralgia 



No funding was received for this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Not applicable; this is a literature review.

Informed consent

Not applicable; this is a literature review.


  1. 1.
    Hooge JP, Redekop WK (1995) Trigeminal neuralgia in multiple sclerosis. Neurology 45:1294–1296CrossRefGoogle Scholar
  2. 2.
    Martinelli Boneschi F, Colombo B, Annovazzi P, Martinelli V, Bernasconi L, Solaro C, Comi G (2008) Lifetime and actual prevalence of pain and headache in multiple sclerosis. Mult Scler 14:514–521CrossRefGoogle Scholar
  3. 3.
    Di Stefano G, Maarbjerg S, Truini A (2019) Trigeminal neuralgia secondary to multiple sclerosis: from the clinical picture to the treatment options. J Headache Pain 20:20CrossRefGoogle Scholar
  4. 4.
    Montano N, Papacci F, Cioni B, Di Bonaventura R, Meglio M (2013) 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 115:567–572CrossRefGoogle Scholar
  5. 5.
    Zakrzewska JM, Wu J, Brathwaite TSL (2018) A systematic review of the management of trigeminal neuralgia in patients with multiple sclerosis. World Neurosurg 111:291–306CrossRefGoogle Scholar
  6. 6.
    Antic B, Peric P (2009) Posterior fossa exploration in treatment of trigeminal neuralgia associated with multiple sclerosis. Surg Neurol 71:419–423 (discussion 423) CrossRefGoogle Scholar
  7. 7.
    Athanasiou TC, Patel NK, Renowden SA, Coakham HB (2005) Some patients with multiple sclerosis have neurovascular compression causing their trigeminal neuralgia and can be treated effectively with MVD: report of five cases. Br J Neurosurg 19:463–468CrossRefGoogle Scholar
  8. 8.
    Broggi G, Ferroli P, Franzini A, Nazzi V, Farina L, La Mantia L, Milanese C (2004) Operative findings and outcomes of microvascular decompression for trigeminal neuralgia in 35 patients affected by multiple sclerosis. Neurosurgery 55:830–838 (discussion 838-839) CrossRefGoogle Scholar
  9. 9.
    Cheng JS, Sanchez-Mejia RO, Limbo M, Ward MM, Barbaro NM (2005) Management of medically refractory trigeminal neuralgia in patients with multiple sclerosis. Neurosurg Focus 18:e13CrossRefGoogle Scholar
  10. 10.
    Eldridge PR, Sinha AK, Javadpour M, Littlechild P, Varma TR (2003) Microvascular decompression for trigeminal neuralgia in patients with multiple sclerosis. Stereotact Funct Neurosurg 81:57–64CrossRefGoogle Scholar
  11. 11.
    Rasche D, Kress B, Schwark C, Wirtz CR, Unterberg A, Tronnier VM (2004) Treatment of trigeminal neuralgia associated with multiple sclerosis: case report. Neurology 63:1714–1715CrossRefGoogle Scholar
  12. 12.
    Resnick DK, Jannetta PJ, Lunsford LD, Bissonette DJ (1996) Microvascular decompression for trigeminal neuralgia in patients with multiple sclerosis. Surg Neurol 46:358–361 (discussion 361–362) CrossRefGoogle Scholar
  13. 13.
    Solaro C, Trabucco E, Messmer Uccelli M (2013) Pain and multiple sclerosis: pathophysiology and treatment. Curr Neurol Neurosci Rep 13:3201CrossRefGoogle Scholar
  14. 14.
    Brichetto G, Messmer Uccelli M, Mancardi GL, Solaro C (2003) Symptomatic medication use in multiple sclerosis. Mult Scler 9:458–460CrossRefGoogle Scholar
  15. 15.
    Österberg A, Boivie J, Thomas KA (2005) Central pain in multiple sclerosis-prevalence and clinical characteristics. Eur J Pain 9:531–542CrossRefGoogle Scholar
  16. 16.
    Solaro C, Brichetto G, Amato MP, Cocco E, Colombo B, D’Aleo G, Gasperini C, Ghezzi A, Martinelli V, Milanese C, Patti F, Trojano M, Verdun E, Mancardi GL, PaIMS Study Group (2004) The prevalence of pain in multiple sclerosis. A multicenter cross-sectional study. Neurology 63:919–921CrossRefGoogle Scholar
  17. 17.
    Montano N, Conforti G, Di Bonaventura R, Meglio M, Fernandez E, Papacci F (2015) Advances in diagnosis and treatment of trigeminal neuralgia. Ther Clin Risk Manag 11:289–299CrossRefGoogle Scholar
  18. 18.
    Di Stefano G, Truini A, Cruccu G (2018) Current and innovative pharmacological options to treat typical and atypical trigeminal neuralgia. Drugs 78:1433–1442CrossRefGoogle Scholar
  19. 19.
    Obermann M (2010) Treatment options in trigeminal neuralgia. Ther Adv Neurol Disord 3:107–115CrossRefGoogle Scholar
  20. 20.
    Leandri M, Lundardi G, Inglese M, Messmer-Uccelli M, Mancardi GL, Gottlieb A, Solaro C (2000) Lamotrigine in trigeminal neuralgia secondary to multiple sclerosis. J Neurol 247:556–558CrossRefGoogle Scholar
  21. 21.
    Pfau G, Brinkers M, Treuheit T, Kretzschmar M, Sentürk M, Hachenberg T (2012) Misoprostol as a therapeutic option for trigeminal neuralgia in patients with multiple sclerosis. Pain Med 13:1377–1378CrossRefGoogle Scholar
  22. 22.
    Zvartau-Hind M, Din MU, Gilani A, Lisak RP, Khan OA (2000) Topiramate relieves refractory trigeminal neuralgia in MS patients. Neurology 55:1587–1588CrossRefGoogle Scholar
  23. 23.
    Cruccu G, Gronseth G, Alksne J, Argoff C, Brainin M, Burchiel K, Nurmikko T, Zakrzewska JM, American Academy of Neurology Society, European Federation of Neurological Society (2008) AAN-EFNS guidelines on trigeminal neuralgia management. Eur J Neurol 15:1013–1028CrossRefGoogle Scholar
  24. 24.
    Bendtsen L, Zakrzewska JM, Abbott J, Braschinsky M, Di Stefano G, Donnet A, Eide PK, Leal PRL, Maarbjerg S, May A, Nurmikko T, Obermann M, Jensen TS, Cruccu G (2019) European Academy of Neurology guideline on trigeminal neuralgia. Eur J Neurol 26:831–849CrossRefGoogle Scholar
  25. 25.
    Montano N, Gaudino S, Giordano C, Pignotti F, Ioannoni E, Rapisarda A, Olivi A (2019) The possible prognostic role of magnetic resonance imaging findings in patients with trigeminal neuralgia and multiple sclerosis submitted to percutaneous balloon compression Report of our series and literature review. World Neurosurg pii: S1878-8750(19):30234–30237. CrossRefGoogle Scholar
  26. 26.
    Montano N, Papacci F, Cioni B, Di Bonaventura R, Meglio M (2012) Percutaneous balloon compression for the treatment of trigeminal neuralgia in patients with multiple sclerosis. Analysis of the potentially prognostic factors. Acta Neurochir (Wien) 154:779–783CrossRefGoogle Scholar
  27. 27.
    Kondziolka D, Lunsford LD, Bissonette DJ (1994) Long-term results after glycerol rhizotomy for multiple sclerosis-related trigeminal neuralgia. Can J Neurol Sci 21:137–140CrossRefGoogle Scholar
  28. 28.
    Berk C, Constantoyannis C, Honey CR (2003) The treatment of trigeminal neuralgia in patients with multiple sclerosis using percutaneous radiofrequency rhizotomy. Can J Neurol Sci 30:220–223CrossRefGoogle Scholar
  29. 29.
    Rogers CL, Shetter AG, Ponce FA, Fiedler JA, Smith KA, Speiser BL (2002) Gamma knife radiosurgery for trigeminal neuralgia associated with multiple sclerosis. J Neurosurg 97(Suppl 5):529–532CrossRefGoogle Scholar
  30. 30.
    Cruccu G, Biasiotta A, Di Rezze S, Fiorelli M, Galeotti F, Innocenti P, Mameli S, Millefiorini E, Truini A (2009) Trigeminal neuralgia and pain related to multiple sclerosis. Pain 143:186–191CrossRefGoogle Scholar
  31. 31.
    Pang H, Sun H, Fan G (2019) Correlations between the trigeminal nerve microstructural changes and the trigeminal-pontine angle features [published online ahead of print, 2019 Nov 6]. Acta Neurochir (Wien). CrossRefGoogle Scholar
  32. 32.
    Lummel N, Mehrkens JH, Linn J, Buchholz G, Stahl R, Bochmann K, Brückmann H, Lutz J (2015) Diffusion tensor imaging of the trigeminal nerve in patient with trigeminal neuralgia due to multiple sclerosis. Neuroradiology 57:259–267CrossRefGoogle Scholar

Copyright information

© Belgian Neurological Society 2019

Authors and Affiliations

  • Nicola Montano
    • 1
    Email author
  • Alessandro Rapisarda
    • 1
  • Eleonora Ioannoni
    • 2
  • Alessandro Olivi
    • 1
  1. 1.Institute of NeurosurgeryFondazione Policlinico Universitario A. Gemelli IRCCS, Catholic UniversityRomeItaly
  2. 2.Neurosurgical Intensive Care UnitFondazione Policlinico Universitario A. Gemelli IRCCS, Catholic UniversityRomeItaly

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