Research: surgery for facial pain

Mohammadi et al. Surgical outcomes of trigeminal neuralgia in patients with multiple sclerosis. Neurosurgery. 2012;71(2):E563-4.

INTRODUCTION: Trigeminal neuralgia (TN) is relatively frequent in Multiple Sclerosis (MS) patients and procedural treatments are less effective than when used for classical TN. Outcomes from direct comparisons between different procedures for MS-related TN is lacking. In this study, initial pain-free rates (IPFR), duration of pain-free intervals (PFI) and associated prognostic factors were evaluated.





METHODS: This was a retrospective IRB-approved analysis performed on 96 MS-related TN patients who underwent 277 procedures (1-11/patient) in our institution (1996-2011). Patient, disease and treatments characteristics, as well as outcomes were statistically evaluated.

RESULTS: Most patients were female (60%). Median age at diagnosis of MS and TN were 39 and 50 years, respectively. 44 patients (47%) had brainstem plaques on MRI. At treatment, most of the patients had secondary-progressive (33%) or relapsing-remitting (31%) MS and 50% were receiving MS treatment. Overall, 89 patients (32%) underwent Glycerol Injection (GI), 82 (30%) Balloon Compression (BC), 54 (19%) Stereotactic Radiosurgery (SRS) and 52 (19%) other procedures. As upfront treatments GI (41%) and SRS (24%) were most common. IPFR was 72%, BC had the best (77%) and SRS the worst (56%) results. Overall failure-rate after 277 procedures was 77% with no significant difference between treatment modalities. Median PFI as 9 months. BC had the best (12 months) and SRS the worst (5 month) median PFI. Complications occurred after 94 procedures (34%), 77 of them (28%) were temporary or minor. SRS had the lowest complication rate (10%). In multivariable analysis, treatment type had significant effect on IPFR with better results for BC and GI.

CONCLUSION: The results of treatment in MS-related TN are suboptimal. In our large series, treatment failure occurred frequently (77%) independent of procedure type. The best IPFRs were achieved after BC and GI. SRS had the lowest complication rate (10%) but also the lowest IPFR (56%) and the shortest PFI (5 months).




Facial Pain is common in MS and is difficult to treat often because the pain is in part generated in the spinal cord and brain rather than in nerves in the face. This study looks at different treatment options and found that Balloon Compression (BC) of facial nerves was the most effective. However, there was failure of most treatments. Balloon compression gave approximately one year of pain-free time.

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