2025 Proffered Presentations
S378: LONG-TERM OUTCOMES OF MICROVASCULAR DECOMPRESSION FOR TRIGEMINAL NEURALGIA IN PATIENTS WITH MULTIPLE SCLEROSIS: A SYSTEMATIC REVIEW
Hadi Sultan, BS1; Hediye Gholamshahi, MD, MPH2; Mohammadmahdi Sabahi, MD, MPH3; Badih Adada, MD3; Hamid Borghei-Razavi, MD3; 1Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA; 2Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran.; 3Department of Neurological Surgery, Pauline Braathen Neurological Centre, Cleveland Clinic Florida, Weston, Florida, USA.
Background: Trigeminal neuralgia (TN) often presents in patients with multiple sclerosis (MS) and TN symptoms can be one of the first signs of MS. It is estimated that the risk of developing TN as an MS patient is 15-20 times that of an unaffected individual. As a demyelinating disorder, the fundamental pathophysiology of MS has led to lower usage of microvascular decompression (MVD) in the treatment of MS patients with TN. Previous literature has found that significant neurovascular compression occurs simultaneously with demyelinating plaques in MS patients, indicating a possible dual-etiology in the TN pain of MS patients and the possible applicability of the procedure. Thus, this systematic review aims to compile the existing literature on the effectiveness of MVD in TN + MS patients.
Methods: Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed to index Embase, Scopus, Web Of Science, and PubMed databases using the terms “trigeminal neuralgia”, “multiple sclerosis”, and “microvascular decompression” along with a thorough list of synonyms for each object. Case reports, case series, retrospective studies, and prospective studies were included in the review. Screening of records was done by abstract and title. The primary outcome extracted was MVD success, defined as a Barrow Neurological Institute (BNI) score of I, being medication and pain-free, and not undergoing any subsequent intervention for the treatment of TN following MVD at the last follow-up. Relevant demographic and clinical information for patients within studies was extracted where available. Pooled rates are calculated for retrospective and prospective studies only, with no accompanying meta-analysis. Perioperative deaths or deaths within 1 month of MVD were excluded from pooled rate calculations.
Results: A total of 1070 records were identified, with 557 duplicates. Of the 523 records that were screened, 38 were listed for inclusion, and full texts were sought for retrieval. 8 additional reports were also sought for retrieval from reference checking of the initial inclusions. Of these 46 records, 32 were included in the final review. 27 of the 32 (84.4%) reports documenting outcomes of MVD for MS + TN patients reported at least 1 MVD success. The pooled rate of MVD success for patients where outcomes could be ascertained is 34.5%, as in 91 of 264 MS + TN patients achieved a BNI score of I at the last follow-up. Follow-up times were available for 47 of these patients, whose last pain-free follow-up was a mean of 45.3 months post-MVD. Where data was available regarding neurovascular compression detected either on MRI or intraoperatively, 224 of 234 MS+TN patients (95.7%) had some form of neurovascular compression.
Conclusions: Some MS patients with TN may benefit from MVD in the long term. Although, when reported, a majority (95.7%) of MS+TN patients treated with MVD in the existing literature demonstrated neurovascular compression either on MRI or detected during surgery, only a minority of the pooled patient population (34.5%) achieved long-term MVD success, reflecting the difficulty in achieving successful long-term pain-free outcomes compared to classical TN (64.7-76%).