Trigeminal Neuralgia in Multiple Sclerosis Patient Treated With Gamma Knife Neurosurgery

Introduction Multiple sclerosis (MS) is a chronic autoimmune disorder affecting the central nervous system (CNS), characterized by heterogeneous neurological manifestations such as motor dysfunction, sensory deficits, and cognitive decline [1]. Notably, secondary trigeminal neuralgia (TN) occurs with markedly higher prevalence in MS patients compared to the general population, a phenomenon attributed to the frequent presence of demyelinating lesions near the trigeminal root entry zone [2]. In this report, we describe a distinctive case of an MS patient with refractory secondary TN who underwent Gamma Knife radiosurgery (GKRS), highlighting its therapeutic implications in this population. Case Presentation A 64-year-old female with a history of relapsing-remitting MS developed secondary TN. Symptoms included sharp, shooting pain on both sides of the face. Imaging revealed demyelinating lesions in the cerebellar peduncles, midbrain, and pons. Conservative treatment with gabapentin, carbamazepine, amitriptyline, and tramadol yielded insufficient relief, leading to repeated nerve resections. Eventually, GKNS was performed, completely reducing pain on the left side and partially on the right. Discussion Secondary trigeminal neuralgia (TN) is characterized by severe, paroxysmal facial pain, typically resulting from demyelinating lesions in the brainstem that disrupt trigeminal pathways, rather than neurovascular compression as seen in classical TN. Traditional surgical approaches, such as microvascular decompression, are often less effective in these cases and may be poorly tolerated by patients with multiple sclerosis (MS). Consequently, GKRS emerges as a promising alternative, providing a non-invasive, precisely targeted treatment option with a favorable risk profile [1,3,4]. Conclusions This case demonstrates the efficacy of GKRS in managing refractory secondary TN in a patient with relapsingremitting MS, where conventional pharmacological and surgical interventions failed. In addition, this case highlights the value of collaboration between neurologists and neurosurgeons, as neurologists can identify refractory cases and refer patients for timely neurosurgical evaluation.