Jacob Worm (Glostrup/ DK), Navid Noory (Glostrup/ DK), Emil Andonov Smilkov (Glostrup/ DK), Tone Bruvik Heinskou (Glostrup/ DK), Anne Sofie Schott Andersen (Glostrup/ DK), Jacob Bertram Springborg (Copenhagen/ DK), Per Rochat (Copenhagen/ DK), Jette Lautrup Frederiksen (Copenhagen/ DK; Glostrup/ DK), Lars Bendtsen (Glostrup/ DK), Stine Maarbjerg (Glostrup/ DK)
Abstract text (incl. figure legends and references)
Background
Patients with multiple sclerosis (MS) are at increased risk of developing trigeminal neuralgia. Medical treatments for trigeminal neuralgia (TN) secondary to MS (MS-TN) is based on weak evidence and have low efficacy and tolerability issues. Patients are often referred to neurosurgery, but the scientific evidence regarding efficacy and complications in these patients is scarce and inconsistent. We aimed to assess outcome and complications after neurosurgical intervention for MS-TN.
Methods
Patients with MS-TN who underwent microvascular decompression (MVD), glycerol rhizolysis or balloon compression were prospectively included from 2012 to 2019. Preoperatively, we obtained clinical characteristics and performed a 3.0 Tesla MRI in all patients. Postoperative follow-up visits at 3, 6 and 12 months were conducted by independent assessors. Efficacy was assessed using a modified version of the Barrow Neurological Institute score and complications were graded into major and minor complications.
Results
We included 18 patients with MS-TN. Of seven patients treated with MVD, 5 (71%) patients had an excellent or good outcome, one (14%) patient had treatment failure and one (14 %) patient had a fatal outcome. Three (43%) patients had major complications and two (29%) patients had minor complications. Of eleven patients treated with percutaneous procedures, 6 (55%) patients had an excellent or good outcome. Major complications were seen in two (18%) patients and two (18%) patients had minor complications.
Conclusions
Our findings shows that surgical treatment with MVD in MS-TN has a higher complication rate and an outcome inferior to MVD in primary TN. Hence, we recommend the use of percutaneous procedures in MS-TN patients and MVD only in selected patients using advanced neuroimaging to maximize the probability of an excellent outcome.
Figure. Outcome (top) and complications (bottom) in primary trigeminal neuralgia (TN) and TN in multiple sclerosis (MS-TN).