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Updated: Jul 3, 2026
Subcutaneous Trigeminal Nerve Field Stimulation for Refractory Facial Pain
Published on: May 10, 2017
Posterior fossa exploration in treatment of trigeminal neuralgia associated with multiple sclerosis
Branislav Antic1, Predrag Peric
1Department of Neurosurgery, Military Medical Academy, 11000 Belgrade, Serbia. dr_branislav_antic@yahoo.com
Background:
The possible surgical options during PFE in treatment of TN in patients with MS are MVD and PSR. Only sporadic cases of PSR in treatment of TN patients with MS have been reported.
Methods:
We retrospectively analyzed the outcome of surgical treatment in 8 patients with MS who underwent PFE due to surgical treatment of medically intractable TN. MVD was projected in severe neurovascular conflict, MVD + PSR in mild conflict, and PSR alone in cases without neurovascular conflict.
Results:
There were no patients with severe neurovascular contact. In 5 patients with mild neurovascular contact and in 3 without neurovascular contact, MVD + PSR and PSR alone were performed, respectively. An immediate BNI-score of I was achieved in all patients. There were 2 minor and 1 major recurrences. Nine years after surgery, 75% of the patients were free of pain. There was no immediate postoperative mortality. Postoperative cerebrospinal fluid rhinorrhea in 1 patient was resolved with spinal drainage. Two patients died during the follow-up period due to the complications of MS.
Conclusion:
In our experience, MVD + PSR or PSR alone are safe and effective surgical procedures in the management of TN complicating MS. In MVD + PSR patients, PSR seems to play more significant role than MVD in pain relief. Since there were not severe neurovascular conflicts in our patients with MS, MVD alone was never justified.
Insights
Microvascular decompression (MVD) plus posterior fossa exploration (PSR) or PSR alone are effective for trigeminal neuralgia (TN) in patients with multiple sclerosis (MS). PSR appears more crucial for pain relief than MVD.
Area of Science:
- Neurosurgery
- Neurology
- Pain Management
Background:
- Trigeminal neuralgia (TN) in multiple sclerosis (MS) patients presents limited surgical options.
- Microvascular decompression (MVD) and posterior fossa exploration (PSR) are potential treatments.
- Posterior fossa exploration (PSR) for TN in MS is rarely reported.
Purpose of the Study:
- To evaluate the outcomes of surgical interventions for TN in patients with MS.
- To compare the effectiveness of MVD and PSR in managing TN with MS.
Main Methods:
- Retrospective analysis of 8 MS patients with medically intractable TN.
- Surgical procedures included MVD, PSR, or combined MVD + PSR based on neurovascular conflict severity.
- Outcomes assessed by immediate pain relief (BNI-score) and long-term pain recurrence.
Main Results:
- No patients had severe neurovascular conflict; MVD + PSR and PSR alone were performed.
- All patients achieved immediate pain relief (BNI-score I).
- 75% pain relief at 9 years; 2 minor and 1 major recurrence; no immediate mortality.
Conclusions:
- MVD + PSR or PSR alone are safe and effective for TN in MS.
- PSR may be more critical than MVD for pain relief in these patients.
- MVD alone was not indicated due to the absence of severe neurovascular conflicts.
