The Effectiveness of Percutaneous Balloon Compression, Thermocoagulation, and Glycerol Rhizolysis for Trigeminal Neuralgia in Multiple Sclerosis

Abstract

BACKGROUND Balloon compression (BC), thermocoagulation (TC), and glycerol rhizolysis (GR) are percutaneous surgical options for trigeminal neuralgia (TN). Whether the outcomes of these procedures in multiple sclerosis -related TN (MS-TN) are as effective as in idiopathic TN (ITN) is unknown. OBJECTIVE To retrospectively compare pain relief, complications, and durability achieved by these 3 types of procedures in MS-TN and ITN. METHODS Two hundred and four patients with typical TN were treated percutaneously: 33 had MS-TN (64 procedures) and 171 had ITN (329 procedures). All were performed by 1 of 2 neurosurgeons; interviews enabled long-term data to be gathered by an independent observer. RESULTS MS-TN patients (53.1%) had Barrow Neurological Institute pain scores of I or II after a percutaneous procedure, compared with 59.3% in the ITN cohort; there was no difference in initial relief between the 2 groups overall (P = .52). There was a trend toward fewer complications in MS-TN compared with ITN (23.4% vs 33.7%, respectively; P = .058). Kaplan–Meier analysis demonstrated no difference in durability of relief in MS-TN (median 23.0 mo) compared with ITN overall (median 24.0 mo; P = .75). Subgroup analysis demonstrated longer relief from BC and TC compared with GR in MS-TN (P = .013). Multivariate analysis confirmed that although the presence of MS does not predict durability of outcome, postoperative numbness (P = .0046) and undergoing a repeat procedure (P = .037) were significant predictors. CONCLUSION BC and TC are safe and effective in MS-TN. Postoperative numbness is the strongest prognostic factor in MS-TN.

Myelin sheath structure and regeneration in peripheral nerve injury repair

“…Structural abnormalities in the myelin sheath (1) can lead to a variety of neurological conditions (2–5), such as Alzheimer’s disease (6), Pelizaeus-Merzbacher disease (7), multiple sclerosis (8), experimental allergic encephalomyelitis (9), and pathological neuropathic pain (10). The morphology of the myelin sheath differs slightly among the brain, spinal cord, and peripheral nerves, but all have an axon that is concentrically wrapped by glial cells, with the myelin sheath formed on the outer surface of the axon.…”

Comparison of Effectiveness and Safety between Intraoperative 3D-CT-Guided and C-Arm-Guided Percutaneous Balloon Compression for Idiopathic Trigeminal Neuralgia: A Multi-Center Retrospective Study

“…Except PBC, other microinvasive approaches, such as gamma knife radiotherapy, glycerol rhizotomy, and radiofrequency thermocoagulation, were also reported to be useful in treatment of ITN [1,[6][7][8][9]. A recently published meta-analysis concerning TN showed that glycerol rhizotomy showed similar rate of immediate pain relief and pain recurrence with PBC but showed lower incidences of numbness and diplopia, while the incidences of other complications were similar in both groups [9].…”

“…Different from other subgroups where neurovascular compression or underlying diseases can easily be identified, ITN does not show significant abnormalities in electrophysiological tests or MRI scans, which makes etiological targeted surgeries impossible [5]. Other surgeries, such as percutaneous balloon compression (PBC), gamma knife radiotherapy, glycerol rhizotomy, and radiofrequency thermocoagulation, have repeatedly been reported to be useful for pain control in TN for which pharmacological treatments have failed [1,[6][7][8][9]. Among these surgical options, PBC is a commonly used microinvasive technique and shows potential in the control of TN [6,9,10].…”

Comparison of first-time microvascular decompression with percutaneous surgery for trigeminal neuralgia: long-term outcomes and prognostic factors

“…Ten patients who had an MVD were lost to follow-up; 1 patient with a percutaneous procedure (TC) was lost to follow-up ( P = 0.055, 2-sided Fisher’s exact test). Cases with MS or repeat surgery have been reported separately [ 34 , 35 ]. All patients in this work had typical (Burchiel type I [ 8 ]) TN pain, meeting the criteria of pain in the distribution of the trigeminal nerve (Vn); an intermittent, paroxysmal course; shock-like lancinating character; light-touch triggers; and initial response to TN medications.…”

“…The long-term relief rates for MVD have been reported to range between 70 and 80% at 5–10 years in several large series [ 4 , 42 , 52 ]. The relief rates for percutaneous surgery for TN are more variable and influenced by surgical technique and patient factors [ 6 , 20 , 28 , 44 , 46 , 34 , 35 ]. Comparing between studies is often challenging owing to the heterogeneity in outcome measures employed.…”