Comparison of Stereotactic Radiosurgery and Radiofrequency Ablation for Trigeminal Neuralgia in Multiple Sclerosis Patients

2020 ◽  
Vol 98 (6) ◽  
pp. 378-385
Author(s):  
Anthony T. Lee ◽  
Kunal P. Raygor ◽  
Felicia Elefant ◽  
Mariann M. Ward ◽  
Doris D. Wang ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Radiofrequency Ablation ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Treatment Outcomes ◽  
Stereotactic Radiosurgery ◽  
Adequate Pain Relief ◽  
Final Treatment ◽  
Surgical Options ◽  
Multiple Sclerosis Patients

<b><i>Background:</i></b> The optimal treatment for medically refractory trigeminal neuralgia in multiple sclerosis (MS-TN) patients is unknown. <b><i>Objective:</i></b> To compare treatment outcomes between stereotactic radiosurgery (SRS) and radiofrequency ablation (RFA). <b><i>Methods:</i></b> We performed a retrospective study of MS-TN patients treated with SRS or RFA between 2002 and 2019. Outcomes included degree of pain relief, pain recurrence, and sensory changes, segregated based on initial treatment, final treatment following retreatment with the same modality, and crossover patients. <b><i>Results:</i></b> Sixty surgical cases for 42 MS-TN patients were reviewed. Initial pain freedom outcomes and rates of retreatment were similar (SRS: 30%; RFA: 42%). RFA resulted in faster onset of pain freedom (RFA: &#x3c;1 week; SRS: 15 weeks; <i>p</i> &#x3c; 0.001). SRS patients with pain relief had longer intervals to pain recurrence at 2 years (<i>p</i> = 0.044). Final treatment outcomes favored RFA for pain freedom/off-medication outcomes (RFA: 44%; SRS: 11%; <i>p</i> = 0.031), though RFA resulted in more paresthesia (RFA: 81%; SRS: 39%; <i>p</i> = 0.012). Both provided at least 80% of adequate pain relief. Crossover patients did not have improved pain relief. <b><i>Conclusions:</i></b> SRS and RFA are both valid surgical options for MS-TN. Discussion with providers will need to balance patient preference with their unique treatment characteristics.

scholarly journals Management of medically refractory trigeminal neuralgia in patients with multiple sclerosis

2005 ◽  
Vol 18 (5) ◽  
pp. 1-5 ◽  
Author(s):  
Jason S. Cheng ◽  
Rene O. Sanchez-Mejia ◽  
Mary Limbo ◽  
Mariann M. Ward ◽  
Nicholas M. Barbaro
Keyword(s):  
Multiple Sclerosis ◽  
Radiofrequency Ablation ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
San Francisco ◽  
Clinical History ◽  
Senior Author ◽  
Electrical Shock ◽  
Complete Pain Relief

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.

Percutaneous glycerol rhizotomy for trigeminal neuralgia in patients with multiple sclerosis: a long-term retrospective cohort study

2020 ◽  
Vol 132 (5) ◽  
pp. 1405-1413 ◽  
Author(s):  
Michael D. Staudt ◽  
Holger Joswig ◽  
Gwynedd E. Pickett ◽  
Keith W. MacDougall ◽  
Andrew G. Parrent
Keyword(s):  
Multiple Sclerosis ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Retrospective Chart Review ◽  
Medication Usage ◽  
Free Response ◽  
Free Survival ◽  
Time To Recurrence ◽  
Significant Difference

OBJECTIVEThe prevalence of trigeminal neuralgia (TN) in patients with multiple sclerosis (MS-TN) is higher than in the general population (idiopathic TN [ITN]). Glycerol rhizotomy (GR) is a percutaneous lesioning surgery commonly performed for the treatment of medically refractory TN. While treatment for acute pain relief is excellent, long-term pain relief is poorer. The object of this study was to assess the efficacy of percutaneous retrogasserian GR for the treatment of MS-TN versus ITN.METHODSA retrospective chart review was performed, identifying 219 patients who had undergone 401 GR procedures from 1983 to 2018 at a single academic institution. All patients were diagnosed with medically refractory MS-TN (182 procedures) or ITN (219 procedures). The primary outcome measures of interest were immediate pain relief and time to pain recurrence following initial and repeat GR procedures. Secondary outcomes included medication usage and presence of periprocedural hypesthesia.RESULTSThe initial pain-free response rate was similar between groups (p = 0.726): MS-TN initial GR 89.6%; MS-TN repeat GR 91.9%; ITN initial GR 89.6%; ITN repeat GR 87.0%. The median time to recurrence after initial GR was similar between MS-TN (2.7 ± 1.3 years) and ITN (2.1 ± 0.6 years) patients (p = 0.87). However, there was a statistically significant difference in the time to recurrence after repeat GR between MS-TN (2.3 ± 0.5 years) and ITN patients (1.2 ± 0.2 years; p < 0.05). The presence of periprocedural hypesthesia was highly predictive of pain-free survival (p < 0.01).CONCLUSIONSPatients with MS-TN achieve meaningful pain relief following GR, with an efficacy comparable to that following GR in patients with ITN. Initial and subsequent GR procedures are equally efficacious.

Idiopathic Trigeminal Neuralgia: A Case Report

2018 ◽  
Vol 31 (04) ◽  
pp. 254-258
Author(s):  
Shruti Jain ◽  
Chetna Lamba
Keyword(s):  
Case Report ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Conventional Medicine ◽  
Positive Role ◽  
Idiopathic Trigeminal Neuralgia ◽  
Adequate Pain Relief ◽  
The Face

AbstractTrigeminal neuralgia (TN) is the most frequent type of neuropathic facial pain affecting one or more branches of trigeminal nerve. Here, a 51-year-old woman diagnosed with idiopathic trigeminal neuralgia (ITN) presented with complaints of pain over right side of the face with redness of the eyes and excessive lachrymation since 5 years with weekly acute episodes of shooting pain. Chelidonium was chiefly prescribed followed by few doses of Spigelia as per indications which provided adequate pain relief. The complaints flared up following stressful circumstances for which Pulsatilla was prescribed after detailed case taking. The frequency, duration and intensity of pain reduced after homoeopathic treatment. The need for conventional medicine was also reduced. This suggests positive role of individualised homoeopathy in the treatment of ITN. Further studies should be undertaken to evaluate the role of homoeopathy in ITN.

A Retrospective Review of the Outcomes and Utility of Percutaneous Radiofrequency Rhizotomy for Trigeminal Neuralgia Using Anatomic Landmark Guidance in Asleep Patients

2019 ◽  
Vol 18 (5) ◽  
pp. 551-558 ◽  
Author(s):  
Lauren E Stone ◽  
Steven M Falowski
Keyword(s):  
Multiple Sclerosis ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Pain Intensity ◽  
Retrospective Review ◽  
Anatomic Landmark ◽  
Continuous Sedation ◽  
Medication Changes ◽  
Relapse Rates ◽  
Repeat Procedures

Abstract BACKGROUND Radiofrequency rhizotomy is a percutaneous procedure for trigeminal neuralgia frequently performed with intermittent awakening, although the utility and accuracy of this procedure in continuously sedated patients have not yet been evaluated. OBJECTIVE To evaluate pain relief in patients with trigeminal neuralgia undergoing radiofrequency rhizotomy under continuous sedation. METHODS Patients from 2012 to 2017 who underwent radiofrequency rhizotomy for trigeminal neuralgia were evaluated retrospectively. Barrow Neurological Institute Pain Intensity scores were assigned to determine relapse at 1 mo, 1 yr, 3 yr, and 5 yr. Descriptive relapse rates for patients with multiple sclerosis and those undergoing repeat procedures are also reported. RESULTS A total of 90.8% of procedures reported Barrow Neurological Institute I-III score at 1 mo (P &lt; .0001), 66.3% at 1 yr (P = .0012), and 71.1% at 3 yr (P = .0003). Duration to relapse was 3.0 and 6.0 at 1 and 3 yr, respectively. Procedures in patients with multiple sclerosis reported 100% relief at 1 mo and 87.5% relief at 1 yr (P = .0099). The presence of numbness and postoperative medication changes were not associated with pain relief (P = .0063, P = .1338). CONCLUSION The use of continuous sedation in radiofrequency rhizotomy for trigeminal neuralgia provides pain relief comparable to the recorded literature rate for procedures with intermittent awakening.

Hypothalamic stimulation for trigeminal neuralgia in multiple sclerosis patients: efficacy on the paroxysmal ophthalmic pain

2009 ◽  
Vol 15 (11) ◽  
pp. 1322-1328 ◽  
Author(s):  
R. Cordella ◽  
A. Franzini ◽  
L. La Mantia ◽  
C. Marras ◽  
A. Erbetta ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Deep Brain Stimulation ◽  
Trigeminal Neuralgia ◽  
Posterior Hypothalamus ◽  
Corneal Reflex ◽  
Multiple Sclerosis Patients ◽  
Ablative Procedures ◽  
Paroxysmal Pain ◽  
Deep Brain

Trigeminal neuralgia is a disorder characterized by paroxysmal pain arising in one or more trigeminal branches; it is commonly reported in multiple sclerosis. In multiple sclerosis patients the ophthalmic branch may be frequently involved and the risks carried by neurosurgical ablative procedures are higher including major adverse effects such as corneal reflex impairment and keratitis. The objective of this works is to assess the role of posterior hypothalamus neuromodulation in the treatment of trigeminal neuralgia in multiple sclerosis patients. Five multiple sclerosis patients suffering from refractory recurrent trigeminal neuralgia involving all three trigeminal branches underwent deep brain stimulation of the posterior hypothalamus. The rationale of this intervention emerges from our earlier success in treating pain patients suffering from trigeminal autonomic cephalalgias. After follow-up periods that ranged from 1 to 4 years after treatment, the paroxysmal pain arising from the first trigeminal branch was controlled, whereas the recurrence of pain in the second and third trigeminal branches necessitated repeated thermorhizotomies to control in pain in two patients after 2 years of follow-up. In conclusion, deep brain stimulation may be considered as an adjunctive procedure for treating refractory paroxysmal pain within the first trigeminal division so as to avoid the complication of corneal reflex impairment that is known to follow ablative procedures.

scholarly journals LINAC stereotactic radiosurgery for trigeminal neuralgia –retrospective two-institutional examination of treatment outcomes

2018 ◽  
Vol 13 (1) ◽  
Author(s):  
Ali Rashid ◽  
Bogdan Pintea ◽  
Thomas M. Kinfe ◽  
Gunnar Surber ◽  
Klaus Hamm ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Treatment Outcomes ◽  
Stereotactic Radiosurgery
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