Gamma knife radiosurgery for multiple sclerosis–related trigeminal neuralgia

Douglas Kondziolka, MD, MSc

Peter J. Jannetta Professor and Vice-Chairman of Neurological Surgery
Professor of Radiation Oncology
University of Pittsburgh
Pittsburgh, Pennsylvania

Multiple sclerosis related to trigeminal neuralgia (MSTN) is a severely disabling disorder characterized by paroxysmal episodes of face pain. Potential surgical options for MSTN that is not controlled by medical management include percutaneous rhizotomy, stereotactic radiosurgery, and microsurgical nerve section. Zorro et al. carried out a study to evaluate clinical outcomes from gamma knife radiosurgery, a minimally invasive technique that uses intersecting radiation beams to target the trigeminal nerve. Among 37 patients with refractory MSTN, complete pain relief and reasonable pain control were noted at some point after the intervention in 23 patients (62.1%) and 36 patients (97.3%), respectively. Potential complications include facial sensory dysfunction, although the observed rate was low in this study—5.4% of patients developed new onset of nondisabling paresthesias. The low incidence of complications compared with other surgical approaches suggests that gamma knife radiosurgery can play an important role in the management of refractory MSTN.

References

Zorro O, Lobato-Polo J, Kano H, et al. Gamma knife radiosurgery for multiple sclerosis-related trigeminal neuralgia. Neurology. 2009;73(14):1149-1154.
Rogers CL, Shetter AG, Ponce FA, et al. Gamma knife radiosurgery for trigeminal neuralgia associated with multiple sclerosis. J Neurosurg. 2002;97:529-532.
Hooge JP, Redekop WK. Trigeminal neuralgia in multiple sclerosis. Neurology. 1995;45:1294-1296.

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