The Effectiveness of Percutaneous Balloon Compression, Thermocoagulation, and Glycerol Rhizolysis for Trigeminal Neuralgia in Multiple Sclerosis.
Adult
Aged
Balloon Occlusion
/ methods
Electrocoagulation
/ methods
Female
Follow-Up Studies
Glycerol
/ administration & dosage
Humans
Male
Middle Aged
Multiple Sclerosis
/ diagnosis
Pain Management
/ methods
Pain Measurement
/ methods
Radiofrequency Ablation
/ methods
Retrospective Studies
Treatment Outcome
Trigeminal Neuralgia
/ diagnosis
Balloon compression
Glycerol
Multiple sclerosis
Thermocoagulation
Trigeminal neuralgia
Journal
Neurosurgery
ISSN: 1524-4040
Titre abrégé: Neurosurgery
Pays: United States
ID NLM: 7802914
Informations de publication
Date de publication:
01 10 2019
01 10 2019
Historique:
received:
20
08
2018
accepted:
28
02
2019
pubmed:
9
4
2019
medline:
9
4
2020
entrez:
9
4
2019
Statut:
ppublish
Résumé
Balloon compression (BC), thermocoagulation (TC), and glycerol rhizolysis (GR) are percutaneous surgical options for trigeminal neuralgia (TN). Whether the outcomes of these procedures in multiple sclerosis -related TN (MS-TN) are as effective as in idiopathic TN (ITN) is unknown. To retrospectively compare pain relief, complications, and durability achieved by these 3 types of procedures in MS-TN and ITN. Two hundred and four patients with typical TN were treated percutaneously: 33 had MS-TN (64 procedures) and 171 had ITN (329 procedures). All were performed by 1 of 2 neurosurgeons; interviews enabled long-term data to be gathered by an independent observer. MS-TN patients (53.1%) had Barrow Neurological Institute pain scores of I or II after a percutaneous procedure, compared with 59.3% in the ITN cohort; there was no difference in initial relief between the 2 groups overall (P = .52). There was a trend toward fewer complications in MS-TN compared with ITN (23.4% vs 33.7%, respectively; P = .058). Kaplan-Meier analysis demonstrated no difference in durability of relief in MS-TN (median 23.0 mo) compared with ITN overall (median 24.0 mo; P = .75). Subgroup analysis demonstrated longer relief from BC and TC compared with GR in MS-TN (P = .013). Multivariate analysis confirmed that although the presence of MS does not predict durability of outcome, postoperative numbness (P = .0046) and undergoing a repeat procedure (P = .037) were significant predictors. BC and TC are safe and effective in MS-TN. Postoperative numbness is the strongest prognostic factor in MS-TN.
Sections du résumé
BACKGROUND
Balloon compression (BC), thermocoagulation (TC), and glycerol rhizolysis (GR) are percutaneous surgical options for trigeminal neuralgia (TN). Whether the outcomes of these procedures in multiple sclerosis -related TN (MS-TN) are as effective as in idiopathic TN (ITN) is unknown.
OBJECTIVE
To retrospectively compare pain relief, complications, and durability achieved by these 3 types of procedures in MS-TN and ITN.
METHODS
Two hundred and four patients with typical TN were treated percutaneously: 33 had MS-TN (64 procedures) and 171 had ITN (329 procedures). All were performed by 1 of 2 neurosurgeons; interviews enabled long-term data to be gathered by an independent observer.
RESULTS
MS-TN patients (53.1%) had Barrow Neurological Institute pain scores of I or II after a percutaneous procedure, compared with 59.3% in the ITN cohort; there was no difference in initial relief between the 2 groups overall (P = .52). There was a trend toward fewer complications in MS-TN compared with ITN (23.4% vs 33.7%, respectively; P = .058). Kaplan-Meier analysis demonstrated no difference in durability of relief in MS-TN (median 23.0 mo) compared with ITN overall (median 24.0 mo; P = .75). Subgroup analysis demonstrated longer relief from BC and TC compared with GR in MS-TN (P = .013). Multivariate analysis confirmed that although the presence of MS does not predict durability of outcome, postoperative numbness (P = .0046) and undergoing a repeat procedure (P = .037) were significant predictors.
CONCLUSION
BC and TC are safe and effective in MS-TN. Postoperative numbness is the strongest prognostic factor in MS-TN.
Identifiants
pubmed: 30957177
pii: 5430784
doi: 10.1093/neuros/nyz103
doi:
Substances chimiques
Glycerol
PDC6A3C0OX
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
E684-E692Informations de copyright
Copyright © 2019 by the Congress of Neurological Surgeons.