Percutaneous Surgical Approaches in Multiple Sclerosis-Related Trigeminal Neuralgia: A Systematic Review and Meta-analysis

World Neurosurg. 2021 Feb;146:342-350.e1. doi: 10.1016/j.wneu.2020.11.006. Epub 2020 Nov 7.

Abstract

Objective: The prevalence of trigeminal neuralgia (TN) in the setting of multiple sclerosis (MS) is reported to be 20-fold higher than in the general population. In these patients, TN can be medically refractory and often requires neurosurgical interventions. Ablative percutaneous approaches such as balloon compression (BC), glycerol rhizolysis (GR), and radiofrequency ablation (RF) can be used and often provide rapid pain relief. The aim of this meta-analysis was to compare the safety and efficacy profile of these approaches.

Methods: This study was performed according to the PRISMA guidelines. A random effects model meta-analysis was conducted.

Results: Five studies with 481 percutaneous approaches were included. No differences in terms of immediate pain relief were identified between BC and GR (odds ratio [OR]: 0.94; 95% confidence interval [CI]: 0.52-1.71). BC was associated with statistically significant higher odds of postoperative mastication weakness compared to GR (OR: 8.58; 95% CI: 1.52-48.43). The rates of pain recurrence (OR: 1.19; 95% CI: 0.04-40.12), hypoesthesia (OR: 0.98; 95% CI: 0.51-1.87), and reduced corneal reflex (OR: 1.07; 95% CI: 0.18-6.17) were similar between BC and GR. In addition, no differences in terms of immediate pain relief (OR: 2.01; 95% CI: 0.77-5.27), pain recurrence (OR: 5.37; 95% CI: 0.30-97.43), and hypoesthesia (OR: 0.63; 95% CI: 0.02-17.66) were identified between RF and GR. The comparison between BC versus RF showed similar rates of immediate pain relief (OR: 0.50; 95% CI: 0.10-2.44), pain recurrence (OR: 1.04; 95% CI: 0-325.96), and hypoesthesia (OR: 2.63; 95%CI: 0.01-735.71).

Conclusions: No significant differences in the immediate pain relief rates between BC, GR, and RF in MS patients were found. However, BC was associated with a higher risk of postoperative mastication weakness compared with GR.

Keywords: Balloon compression; Glycerol rhizolysis; Multiple sclerosis; Radiofrequency ablation; Trigeminal neuralgia.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Balloon Occlusion
  • Disease Management
  • Humans
  • Multiple Sclerosis / complications*
  • Nerve Block
  • Neurosurgical Procedures / methods*
  • Radiofrequency Ablation
  • Rhizotomy
  • Treatment Outcome
  • Trigeminal Neuralgia / complications
  • Trigeminal Neuralgia / therapy*