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

Neurosurgery. 2019 Oct 1;85(4):E684-E692. doi: 10.1093/neuros/nyz103.

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.

Keywords: Balloon compression; Glycerol; Multiple sclerosis; Thermocoagulation; Trigeminal neuralgia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Balloon Occlusion / methods*
  • Balloon Occlusion / trends
  • Electrocoagulation / methods*
  • Electrocoagulation / trends
  • Female
  • Follow-Up Studies
  • Glycerol / administration & dosage
  • Humans
  • Male
  • Middle Aged
  • Multiple Sclerosis / diagnosis
  • Multiple Sclerosis / epidemiology
  • Multiple Sclerosis / surgery*
  • Pain Management / methods*
  • Pain Management / trends
  • Pain Measurement / methods
  • Pain Measurement / trends
  • Radiofrequency Ablation / methods*
  • Radiofrequency Ablation / trends
  • Retrospective Studies
  • Treatment Outcome
  • Trigeminal Neuralgia / diagnosis
  • Trigeminal Neuralgia / epidemiology
  • Trigeminal Neuralgia / surgery*

Substances

  • Glycerol