The possible prognostic role of magnetic resonance imaging findings in patients with trigeminal neuralgia and multiple sclerosis submitted to percutaneous balloon compression. Report of our series and literature review.

The possible prognostic role of magnetic resonance imaging findings in patients with trigeminal neuralgia and multiple sclerosis submitted to percutaneous balloon compression. Report of our series and literature review.

World Neurosurg. 2019 Feb 01;:

Authors: Montano N, Gaudino S, Giordano C, Pignotti F, Ioannoni E, Rapisarda A, Olivi A

Abstract
OBJECTIVE: We studied the correlation of magnetic resonance imaging (MRI) findings with the prognosis of multiple sclerosis (MS)-related trigeminal neuralgia (TN) patients submitted to percutaneous balloon compression (PBC). No articles have previously been reported on this topic. We also performed a literature review of the pertinent studies.
METHODS: From a surgical series of 82 TN patients submitted to PBC between January 2013 and June 2017, we identified 16 MS patients (mean age: 54.81±8.51 years and mean follow-up: 38.12±19.86 months). On brain MRI, we evaluated the presence of a lesion in the trigeminal nerve root entry zone and in the trigeminal nuclei and, along with other clinical and procedure-related factors, we studied its impact on the acute pain relief (APR: pain-free at hospital discharge) and on the pain-free survival (PFS).
RESULTS: Fifteen out of sixteen patients (93.75%) reported an APR. Eight patients (50.00%) experienced a recurrence of pain. At latest follow-up, an excellent outcome (BNI I-II) was obtained in 75% of patients and a good outcome (BNI III) in the remaining ones. No patients had an uncontrolled pain. The presence of a pear-like shape of the balloon at the operation (p=0.0053) and the evidence of a MRI detectable lesion in trigeminal pathway (p=0.049) were associated to a higher PFS.
CONCLUSIONS: PBC can be efficient in treating MS-related TN. Some factors such as the pear-like shape of the balloon at the operation and the evidence of a MRI detectable lesion in trigeminal pathway seem to be associated to a higher PFS.

PMID: 30716488 [PubMed - as supplied by publisher]

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