The utility of partial sensory rhizotomy and adjunct procedures in the surgical management of trigeminal neuralgia secondary to multiple sclerosis.

Abstract

Trigeminal neuralgia (TN) secondary to multiple sclerosis (MS) is a debilitating condition with limited treatment options. Partial sensory rhizotomy (PSR) has been utilized as a surgical intervention, although its efficacy and durability remain unclear. This study evaluates the long-term outcomes of PSR alone and in combination with microvascular decompression (MVD) or internal neurolysis (IN) in patients with TN secondary to MS. The records of patients who underwent PSR for TN secondary to MS between 2012 and 2023 were retrospectively analyzed. Patients were categorized into four groups: first PSR, redo PSR, PSR+MVD, and PSR+IN. Demographics, prior treatments, pain outcomes, time to recurrence, and complications were analyzed. A total of 30 patients undergoing 37 procedures were included in the analysis. Patients had undergone another procedure for the treatment of TN on the ipsilateral side prior to 33 of 37 procedures (89.2%). Immediate postoperative pain relief was achieved in 89.2% of cases, with no significant differences between groups. Pain recurred at a mean of 1.64 ± 1.71 years, with no significant differences seen between groups. At the final follow-up (mean 3.14 ± 2.58 years), 75% of PSR+MVD and 100% of PSR+IN cases remained pain free, while 52.3% of first PSR cases required additional procedures. Complication rates did not significantly differ between groups. PSR is an effective salvage procedure for TN secondary to MS, particularly in patients with prior failed treatments. Combining PSR with MVD or IN may enhance long-term pain relief without increasing complication rates. Future prospective studies are needed to validate these findings.