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Gamma Knife radiosurgery for multiple sclerosis-associated trigeminal neuralgia
Gülşah Öztürk Özlük1, Yavuz Samanci2, A Haluk Duzkalir3
1Department of Neurosurgery, Memorial Health Group Sisli Hospital, Istanbul, Turkey.
Summary
Gamma Knife radiosurgery (GKRS) offers pain relief for trigeminal neuralgia (TN) related to multiple sclerosis (MS). While initially effective for many, long-term pain relief and potential side effects require careful patient discussion.
Area of Science:
- Neurosurgery
- Neurology
- Radiation Oncology
Background:
- Trigeminal neuralgia (TN) is a common symptom in multiple sclerosis (MS).
- Gamma Knife radiosurgery (GKRS) is established for idiopathic TN, but its use in MS-related TN is less studied.
- This study evaluates GKRS efficacy and complications for MS-related TN.
Purpose of the Study:
- To analyze the effectiveness of Gamma Knife radiosurgery (GKRS) in treating trigeminal neuralgia (TN) associated with multiple sclerosis (MS).
- To assess the complications and long-term outcomes of GKRS for MS-related TN.
Main Methods:
- Retrospective analysis of 28 patients with MS-related TN treated with GKRS.
- Targeting the cisternal segment of the trigeminal nerve with a median radiation dose of 80 Gy.
- Pain assessment using Barrow Neurological Institute (BNI)-Pain Intensity Scores, with adequate relief defined as BNI 3b or below.
Main Results:
- Initial adequate pain relief achieved in 71.4% of patients.
- At final follow-up, 50% of patients experienced adequate pain relief.
- Complications occurred in 35.7%, including facial sensory dysfunction, corneal reflex decline, and jaw weakness. Pain recurrence was observed in 30% of initial responders.
Conclusions:
- GKRS provides effective pain relief for MS-related TN.
- Potential side effects are comparable to other ablative treatments.
- Benefits and risks should be discussed, especially for patients avoiding surgery or with treatment failures.
