The efficacy of surgical interventions for trigeminal neuralgia in multiple sclerosis: A systematic review.

In 30 seconds

This systematic review with narrative synthesis assessed surgical treatments for trigeminal neuralgia in people with multiple sclerosis, using studies reporting Barrow Neurological Institute Pain Scale outcomes. Thirty-two studies involving 1617 patients were included. Partial sensory rhizotomy had reported initial pain-relief success of 95.3-100%, with recurrence reported over 20.1 to 79 months. Percutaneous procedures and gamma knife radiosurgery also showed pain control, but recurrence and repeat procedures were common considerations. Microvascular decompression appeared durable when neurovascular conflict was demonstrated, with higher risks of serious complications.

Key findings

• Partial sensory rhizotomy had initial success of 95.3-100%; reported recurrence ranged from 20.1 to 79 months.
• Initial success ranged from 58 to 100% for percutaneous procedures and from 52.7 to 97.3% for gamma knife radiosurgery.
• Gamma knife radiosurgery recurrence ranged from 7.4 to 74.5 months; percutaneous procedure recurrence ranged from 8-60 months.
• Microvascular decompression was associated with durable outcomes when neurovascular conflict was demonstrated, but serious complications included one fatality.

Why it matters

The review brings together evidence on several surgical options for a medication-refractory pain condition in multiple sclerosis, where outcomes and durability vary. Its findings highlight the need to weigh pain relief against recurrence and procedure-specific harms, while recognising that the evidence base is heterogeneous and does not establish a single best approach.

What to keep in mind

The review used narrative synthesis of 32 studies, and the abstract notes diagnostic uncertainty in attributing pain to multiple sclerosis when neurovascular conflict is also present. Prospective studies and standardised outcome reporting are needed.