Microvascular Decompression for Trigeminal Neuralgia in Patients with Multiple Sclerosis

Abstract

Aims: To assess whether microvascular decompression (MVD) is a safe and efficacious treatment for patients with trigeminal neuralgia (TGN) and multiple sclerosis (MS). Methods: Case records were reviewed of all patients with TGN and MS who underwent posterior fossa exploration with a view to MVD between 1993 and 2001. In all patients, magnetic resonance tomoangiography (MRTA) demonstrated vascular compression. Results: Nine patients were included in the study. Seven patients underwent MVD alone; in 2 patients a partial sensory rhizotomy of the trigeminal nerve was added to the decompression. All patients had excellent initial pain relief. Recurrence of neuralgia was noted in 5 patients after MVD and in 1 of the 2 patients after partial sensory rhizotomy. Long-term pain relief was obtained in 1 patient who underwent a redo MVD after postoperative MRTA scans demonstrated recurrent vascular compression of the root entry zone (REZ). Thus only 4 out of 9 patients maintained pain relief. In addition, 3 patients experienced transient worsening of their MS. Conclusions: Although MVD provides good initial pain relief, the recurrence rate is much higher than that obtained in ‘idiopathic’ TGN. Although all procedures for the treatment of TGN are worse than those for idiopathic TGN, it is concluded that because of the high recurrence rate together with the morbidity associated with the procedure MVD should not be offered to patients with TGN and MS.

Multiple Sclerosis-Related Trigeminal Neuralgia: A Prospective Series of 43 Patients Treated with Gamma Knife Surgery with More than One Year of Follow-Up

“…Even in this former case some authors suggested less efficacy and increased side effects for MS-related TN cases, e.g. Broggi et al [31] and Eldridge et al [32] for microvascular decompression, Kanpolat et al [5] for radiofrequency lesioning and Kondziolka et al [6] for glycerol rhizotomy. This is probably related to a different physiopathological context, disease related.…”

Pain in multiple sclerosis: A systematic review of neuroimaging studies

“…1). Thirty-eight met the inclusion criteria (Alstadhaug et al, 2008; Andrade et al, 2012; Athanasiou et al, 2005; Balasa and Bajko, 2010; Bentley et al, 2002; Broggi et al, 2004; Burkey and Abla-Yao, 2010; Carrieri et al, 2009; Cordella et al, 2009; Cruccu et al, 2009; da Silva et al, 2005; Davey and Al-Din, 2004; Deppe et al, 2013; de Santi et al, 2009; Donat, 2012; Eldridge et al, 2003; Fragoso and Brooks, 2007; Gass et al, 1997; Gee et al, 2005; Gentile et al, 2007; González-Quintanilla et al, 2012; Haas et al, 1993; Hellwig et al, 2006; Kister et al, 2010; Leandri et al, 1999; Liu et al, 2008; Marchettini et al, 2006; Meaney et al, 1995; Minagar and Sheremata, 2000; Nakashima et al, 2001; Pichiecchio et al, 2007; Ramirez-Lassepas et al, 1992; Svendsen et al, 2011; Tanei et al, 2010; Tortorella et al, 2006; Tosi et al, 1998; Vilisaar and Constantinescu, 2006; Yetimalar et al, 2008). Of these, 16 were case reports (Alstadhaug et al, 2008; Andrade et al, 2012; Bentley et al, 2002; Burkey and Abla-Yao, 2010; Carrieri et al, 2009; Davey and Al-Din, 2004; Donat, 2012; Gentile et al, 2007; González-Quintanilla et al, 2012; Haas et al, 1993; Leandri et al, 1999; Liu et al, 2008; Pichiecchio et al, 2007; Tanei et al, 2010; Tosi et al, 1998; Vilisaar and Constantinescu, 2006), nine were case series (Athanasiou et al, 2005; Cordella et al, 2009; de Santi et al, 2009; Fragoso and Brooks, 2007; Hellwig et al, 2006; Marchettini et al, 2006; Meaney et al, 1995; Minagar and Sheremata, 2000; Nakashima et al, 2001), and 13 were investigational studies (<...>…”

“…We found that field strength was specified in 15 studies (39% of all studies). Of these 15 studies, one tesla scanners were used in two studies (Balasa and Bajko, 2010; da Silva et al, 2005), 1.5 T scanners were used in nine studies (Eldridge et al, 2003; Gass et al, 1997; Gee et al, 2005; Meaney et al, 1995; Nakashima et al, 2001; Pichiecchio et al, 2007; Svendsen et al, 2011; Tortorella et al, 2006; Yetimalar et al, 2008), and 3 T scanners were used in two (of the most recent) studies (Andrade et al, 2012; Deppe et al, 2013). Scanners of varying strengths were employed in two studies: 0.6, 1.5 and 3 T (Kister et al, 2010), and 0.5 and 1.5 T (Broggi et al, 2004).…”

“…Scanners of varying strengths were employed in two studies: 0.6, 1.5 and 3 T (Kister et al, 2010), and 0.5 and 1.5 T (Broggi et al, 2004). Of all the included studies, MRI protocols were stated only in 14 (37%) (Andrade et al, 2012; Athanasiou et al, 2005; Broggi et al, 2004; da Silva et al, 2005; Deppe et al, 2013; Donat, 2012; Eldridge et al, 2003; Gass et al, 1997; González-Quintanilla et al, 2012; Haas et al, 1993; Kister et al, 2010; Meaney et al, 1995; Svendsen et al, 2011; Tortorella et al, 2006). Of the 14 studies that did describe the MRI protocol used, only nine of these described all the sequences (Broggi et al, 2004; da Silva et al, 2005; Deppe et al, 2013; Gass et al, 1997; Haas et al, 1993; Kister et al, 2010; Meaney et al, 1995; Svendsen et al, 2011; Tortorella et al, 2006), and only four described all the sequence parameters of all the sequences (da Silva et al, 2005; Gass et al, 1997; Svendsen et al, 2011; Tortorella et al, 2006).…”

Multiple Sclerosis-Related Central Pain Disorders

“…It would be interesting to see if from trigeminal reflexes a signal could be detected that would suggest a superiority of one treatment over the other. Case series even with somewhat variable results show no convincing superiority of any surgical method in this patient group [37][38][39][40]. Given that ganglion and root level neuroablative procedures are less invasive and therefore easier to tolerate by patients, many of whom have significant disability, they may be considered as first-line surgical interventions, with microvascular decompression left for nonresponders.…”