Operative Findings and Outcomes of Microvascular Decompression for Trigeminal Neuralgia in 35 Patients Affected by Multiple Sclerosis

Broggi, Giovanni; Ferroli, Paolo; Franzini, Angelo; Nazzi, Vittoria; Farina, Laura; Mantia, L. La; Milanese, C.

doi:10.1227/01.neu.0000137656.59536.0e

Cited by 124 publications

(68 citation statements)

References 28 publications

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“…Recent literature favors multiple causes, including the possibility of both central MS lesions of the trigeminal pathway and peripheral vascular compression of the trigeminal REZ as causes that are not mutually exclusive. 4,[7][8][9] Initial studies examining the role of MVD for treatment of patients with both MS and TN have yielded mixed results. Resnick, et al, 20 examined five patients who had previously undergone unsuccessful percutaneous procedures, and reported better outcomes in two who had received MVD with partial rhizotomy compared with MVD alone.…”

Section: Resultsmentioning

confidence: 99%

Management of medically refractory trigeminal neuralgia in patients with multiple sclerosis

Cheng¹,

Sanchez-Mejia²,

Limbo³

et al. 2005

FOC

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Object Trigeminal neuralgia (TN) is a painful disorder that frequently causes lancinating, electrical shock–like pain in the trigeminal distribution. Common surgical treatments include microvascular decompression (MVD), radio-surgery, and radiofrequency ablation, and complete pain relief is generally achieved with a single treatment in 70 to 85% of cases for all modalities. In a subset of patients with multiple sclerosis (MS), however, the rates of surgical treatment failure and the need for additional procedures are significantly increased compared with those in patients without MS. In this study the authors report their experience with a cohort of 11 patients with TN who also had MS, and assess the efficacy of MVD, gamma knife surgery (GKS), and radiofrequency ablation in achieving complete or partial long-term pain relief. Methods Eleven patients with TN and MS who were treated by the senior author (N.B.) at the University of California, San Francisco were included in this study. All patients underwent GKS and/or radiofrequency ablation, and four received MVD. A detailed clinical history and intraoperative findings were recorded for each patient and frequent follow-up evaluations were performed, with a mean follow-up duration of 40.6 months (range 1–96 months). Pain was assessed for each patient by using the Barrow Neurological Institute scale (Scores I–V). Conclusions Achieving complete pain relief in patients with TN and MS required significantly more treatments compared with all other patients with TN who did not have MS (p = 0.004). Even when compared with a group of 32 patients who had highly refractory TN, the cohort with MS required significantly more treatments (p = 0.05). Radiosurgery proved to be an effective procedure and resulted in fewer retreatments and longer pain-free intervals compared with MVD or radiofrequency ablation.

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Section: Resultsmentioning

confidence: 99%

Management of medically refractory trigeminal neuralgia in patients with multiple sclerosis

Cheng¹,

Sanchez-Mejia²,

Limbo³

et al. 2005

FOC

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“…In the case of MS, a plaque of demyelination encompasses the root entry zone of the trigeminal nerve in the pons [21]. Additionally, several studies have also described the association of a neurovascular conflict in a minority of patients [4,22,23,24]. Love and Coakham [20] demonstrated that demyelination is found to extend along the proximal part of the trigeminal nerve root and, in some cases, right up to its junction with the peripheral nervous system.…”

Section: Discussionmentioning

confidence: 99%

“…Burchiel and Slavin [3 ]classified the MS-related TN as symptomatic. TN secondary to MS is additionally more often difficult to manage pharmacologically and surgically, with lower response rates than CTN [4,5,6]. …”

Section: Introductionmentioning

confidence: 99%

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

Tuleasca

Carron

Resseguier

et al. 2014

Stereotact Funct Neurosurg

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Background: Trigeminal neuralgia (TN) related to multiple sclerosis (MS) is more difficult to manage pharmacologically and surgically. Objective: This article aims to evaluate the safety and efficacy of Gamma Knife surgery (GKS) in this special group of patients. Methods: Between July 1992 and November 2010, 43 cases with more than 1 year of follow-up were operated with GKS for TN related to MS and prospectively evaluated in the Timone University Hospital, Marseille, France. Radiosurgery using the Gamma Knife (model B or C or Perfexion) was performed. A single 4-mm isocenter was positioned at a median distance of 8 mm (range 5.7-14.7) anterior to the emergence of the nerve. A median maximum dose of 85 Gy (range 75-90) was delivered. Results: The median follow-up period was 53.8 months (12-157.1). Thirty-nine patients (90.7%) were initially pain free. Their actuarial probability of remaining pain free without medication at 6 months, 1, 3, 5 and 10 years was 87.2, 71.8, 43.1, 38.3 and 20.5%, respectively, and remained stable till 12 years. The hypoesthesia actuarial rate at 6 months, 1 and 2 years was 11.5, 11.5 and 16%, and remained stable till 12 years. Conclusions: GKS proved safe and effective in this special group of patients.

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“…В тех случаях, ко-гда клиника классической НТН сопровождается чувствительным дефицитом, используют термин чувствительная тригеминальная нейропатия [331,423]. У больных рассеянным склерозом также наблюдается НТН, которую многие авторы относят ко вторичной НТН [63,74,154,158,169,170,184,340,354,365,366,378].…”

Section: от истоков к современному взгляду на патогенезunclassified

Классическая Невралгия Тройничного Нерва

Балязина¹

2015

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Operative Findings and Outcomes of Microvascular Decompression for Trigeminal Neuralgia in 35 Patients Affected by Multiple Sclerosis

Abstract: Results of MVD in trigeminal neuralgia MS patients are much less satisfactory than in the idiopathic group, indicating that central mechanisms play a major role in pain genesis.

Cited by 124 publications

References 28 publications

Management of medically refractory trigeminal neuralgia in patients with multiple sclerosis

Management of medically refractory trigeminal neuralgia in patients with multiple sclerosis

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

Классическая Невралгия Тройничного Нерва

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