Journal of neurosurgery · 2026
Repeat radiofrequency thermocoagulation for multiple sclerosis-associated versus idiopathic trigeminal neuralgia: a comparison of long-term pain control.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Greve Tobias, Kuklinski Mattis, Ringel Florian, Muacevic Alexander, Mehrkens Jan-Hinnerk
Аннотация
OBJECTIVE: Radiofrequency thermocoagulation (RFT) of the gasserian ganglion provides rapid pain relief in trigeminal neuralgia (TN) and is minimally invasive. In multiple sclerosis (MS)-associated TN (MS-TN), recurrence may be more frequent than in idiopathic/classic TN (Id-TN), possibly due to demyelinating pathology. This study compared RFT outcomes between these etiologies.
METHODS: The authors conducted a STROBE-compliant, single-center retrospective cohort study that screened 636 patients with TN treated between March 2012 and September 2021. Structured telephone interviews were completed in 350 patients, including the 5-level EQ-5D (EQ-5D-5L) for health-related quality of life (HRQOL). Of these patients, 182 received RFT as their first invasive treatment. The primary endpoint was the pain-free interval (PFI), defined as the time to recurrence (Barrow Neurological Institute Pain Intensity Scale score ≥ II or medication restart), analyzed using Kaplan-Meier curves and Cox proportional hazards regression models. Secondary outcomes included repeat interventions, permanent sensory deficits, and HRQOL.
RESULTS: Of 182 eligible participants, 77 had MS-TN and 105 had Id-TN. Patients with MS-TN were younger (mean age 55.8 [SD 10.6] vs 70.5 [SD 8.6] years, p < 0.001). The median PFI was 33.9 (95% CI 15.5-52.3) months for MS-TN versus 87.0 (95% CI 43.1-130.9) months for Id-TN (p = 0.0493, log-rank test). The mean overall follow-up duration was 68.4 months. Despite earlier recurrence, repeat interventions achieved comparable adequate pain control at the last follow-up (68.8% in MS-TN vs 77.1% in Id-TN, p = 0.139). EQ-5D-5L scores improved significantly and converged at follow-up (p = 0.085).
CONCLUSIONS: After the first RFT, pain control was shorter in MS-TN than in Id-TN. However, retreatment effectively restored long-term pain control and HRQOL, supporting the role of RFT in managing MS-TN. Regular follow-up is recommended to facilitate timely intervention.
METHODS: The authors conducted a STROBE-compliant, single-center retrospective cohort study that screened 636 patients with TN treated between March 2012 and September 2021. Structured telephone interviews were completed in 350 patients, including the 5-level EQ-5D (EQ-5D-5L) for health-related quality of life (HRQOL). Of these patients, 182 received RFT as their first invasive treatment. The primary endpoint was the pain-free interval (PFI), defined as the time to recurrence (Barrow Neurological Institute Pain Intensity Scale score ≥ II or medication restart), analyzed using Kaplan-Meier curves and Cox proportional hazards regression models. Secondary outcomes included repeat interventions, permanent sensory deficits, and HRQOL.
RESULTS: Of 182 eligible participants, 77 had MS-TN and 105 had Id-TN. Patients with MS-TN were younger (mean age 55.8 [SD 10.6] vs 70.5 [SD 8.6] years, p < 0.001). The median PFI was 33.9 (95% CI 15.5-52.3) months for MS-TN versus 87.0 (95% CI 43.1-130.9) months for Id-TN (p = 0.0493, log-rank test). The mean overall follow-up duration was 68.4 months. Despite earlier recurrence, repeat interventions achieved comparable adequate pain control at the last follow-up (68.8% in MS-TN vs 77.1% in Id-TN, p = 0.139). EQ-5D-5L scores improved significantly and converged at follow-up (p = 0.085).
CONCLUSIONS: After the first RFT, pain control was shorter in MS-TN than in Id-TN. However, retreatment effectively restored long-term pain control and HRQOL, supporting the role of RFT in managing MS-TN. Regular follow-up is recommended to facilitate timely intervention.