Gamma Knife radiosurgery for the treatment of trigeminal neuralgia in patients with multiple sclerosis: A single-center retrospective study and literature review.

Abstract Objective Trigeminal neuralgia (TN) in patients with multiple sclerosis (MS) is a challenging condition to manage that is treated with Gamma Knife radiosurgery (GKRS). The aim of this report is to assess the safety, efficacy, and durability of GKRS for the treatment of TN in patients with MS. Our findings are compared with those of the existing literature and discussed. Methods We retrospectively reviewed all patients at our institution who underwent GKRS for the treatment of TN secondary to MS and had one or more years of follow-up. Pre-operative and post-operative pain intensities and facial numbness were evaluated with the Barrow Neurological Institute (BNI) scores. Durability of successful pain relief was statistically evaluated with Kaplan-Meier analysis. The prognostic role of perioperative factors was investigated and analyzed using Cox proportional hazards regression. Results There were 29 patients with MS-TN who underwent GKRS at our institution. Two patients underwent bilateral treatment. Four patients underwent repeat GKRS for pain recurrence. The median period of follow-up assessment was 33 months. Rates of reasonable pain reduction at 1, 3, and 5 years were 70%, 57%, and 57% respectively. All patients who underwent repeat GKRS had durable pain reduction. No prognostic factor for successful pain reduction was found. Conclusions Our study shows that GKRS for the treatment of TN secondary to MS is a safe and effective procedure in controlling pain in the short term, but often fails to provide long-term pain control. GKRS can be safely repeated to prolong the time of pain reduction.