Stereotactic radiosurgery for secondary trigeminal neuralgia in patients with multiple sclerosis

Objective: to evaluate the eff ects of stereotactic radiosurgery (SRS) in patients with drug-resistant trigeminal neuralgia (TN) secondary to multiple sclerosis (MS). Material and methods. The article presents the results of observation of 14 patients with TN secondary to MS. In order to reduce the intensity of pain syndrome, stereotactic radiosurgery was performed using the Gamma Knife. The irradiation target was the middle third of the cisternal portion of the trigeminal nerve with a maximum dose of 80–90 Gy. Pain intensity before and after SRS, as well as during relapses, was assessed using the visual analogue scale and the Barrow Neurological Institute Pain Scale (BNI PS). Complications of SRS are classifi ed according to the Barrow Neurological Institute facial hypoesthesia scale (BNI fhs). The observation period for patients after SRS was Me = 24.4 [17.5; 41] months. Results. Pain relief after SRS occurred in 85.7% of patients. The improvement developed within 1–2 months after SRS. Complications in the form of hypoesthesia and/or paresthesia were noted in 28.6%. Relapses of the disease were diagnosed in 58.3% of patients after SRS, and in 57% of them the pain was relieved by medications. Conclusion. Stereotactic radiosurgery of patients with MS-related TN is highly eff ective and well tolerated. The use of the Gamma Knife should be considered a priority given the variety of surgical approaches.