Medical Student Columbia University Department of Neurological Surgery
Introduction: Secondary trigeminal neuralgia (TN) attributed to Multiple Sclerosis (MS) involves TN symptoms in a patient with MS. The relative long-term efficacy of percutaneous glycerol rhizotomy (PGR) and open partial sensory rhizotomy (PSR) in the treatment of TN attributed to MS has yet to be studied.
Methods: 97 patients with TN attributed to MS underwent procedures between 2012 and 2024, including 63 patients who underwent 93 PGRs and 22 patients who underwent 26 PSRs. Patients were followed post-operatively either by clinic or telemedicine visits, and these records were reviewed with particular focus on clinical outcomes, imaging, and complications.
Results: The PGR and PSR groups were comparable with respect to mean age (61.0 vs. 59.0 years, respectively), gender (76.2% vs 86.4% female, respectively), and response to carbamazepine/oxcarbazepine (80.1% vs 77.3% responders, respectively). Mean follow-up duration for PGR (2.37 years) and PSR (2.82 years) groups were similar. Rates of immediate pain freedom were not significantly different between PGR (72.0%) and PSR (84.6%) (p=0.22). There was no significant difference in the rate of pain recurrence after PGR (83.9%) versus PSR (73.1%) (p=0.25). Among procedures with subsequent pain recurrence, the mean time to pain recurrence was longer after PSR than after PGR (1.59 vs 1.00 years; p=0.037). Among PGRs with subsequent pain recurrence, the mean time to pain recurrence was longer when PGR was the first procedure for facial pain versus a subsequent procedure (1.51 vs. 0.54 years; p=0.048). Serious complications were more common in the PSR group than the PGR group (11.5% vs. 1.1%; p=0.04).
Conclusion : PGR and PSR provide similar rates of pain relief in patients with TN attributed to MS. The duration of pain relief may be longer after PSR; however, the rate of serious complications may be higher for PSR. Pain relief after PGR lasts longer when PGR is the first procedure for TN.
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