Comparison of Gamma Knife Radiosurgery, Balloon Decompression and Radiofrequency Ablation in the Treatment of Multiple-Sclerosis-Related Trigeminal Neuralgia: a Systematic Review and Meta-Analysis

Introduction: Trigeminal neuralgia (TN) secondary to multiple sclerosis (MS) presents unique challenges, sometimes requiring surgical interventions beyond medical therapy due to refractory pain. Gamma Knife radiosurgery (GKSRS), balloon compression (BC), and radiofrequency ablation (RFA) are established procedures to manage MS-related TN, each with distinct efficacy and complication profiles. This study compares the effectiveness of GKSRS, BC, and RFA in treating MS-related TN.

Methods: A comprehensive literature search was performed using PubMed, Embase, Web of Science, Scopus, and Cochrane Library. Inclusion criteria were MS-related TN patients who underwent GKSRS, BC, or RFA with a minimum 1-year follow-up. Twenty-four studies including 824 patients treated with GKSRS, 263 patients with BC, and 183 patients with RFA were analyzed. Single-proportion meta-analyses for initial pain relief, overall pain control, and complication rate were conducted. A random effects model was used to account for heterogeneity and inter-study variability.

Results: BC demonstrated significantly greater overall pain control than GKSRS (64% vs 47%; 95% CI [56%, 72%] vs [32%, 62%], p=0.05). GKSRS showed a statistically significant lower complication rate compared to BC (8% vs. 18%; 95% CI [2%, 13%] vs. [12%, 23%]; p=0.01). Although not statistically significant, RFA showed greater overall pain control than GKSRS (73% vs. 47%, 95% CI [48%, 97%] vs [32%, 62%]; p=0.09). Initial pain relief, overall pain control, and complication rates were comparable for BC and RFA subgroups.

Conclusion : While initial pain relief was comparable among GKSRS, BC, and RFA, BC and RFA were associated with superior overall pain control compared to GKSRS. However, GKSRS exhibited a lower complication rate relative to BC, offering a potentially safer option for patients at higher risk of adverse effects. This analysis suggests BC and RFA may be preferable for long-term pain management, while GKSRS may offer a more favorable safety profile.