Balloon Rhizotomy for the Treatment of Refractory Trigeminal Neuralgia Secondary to Multiple Sclerosis: A Case Series
Christopher Bondoc1, Hsinlin Cheng2, Jeffrey Schweitzer2, Megan Heffernan3
1True North Neurology, 2Massachusettes General Hospital, 3MGH
Objective:
To present a series of cases in which percutaneous balloon rhizotomy was used as a treatment for medically refractory trigeminal neuralgia (TN) secondary to multiple sclerosis (MS).
Background:
TN is a facial pain disorder characterized by severe, episodic, lancinating facial pain. Often times it is due to a lesion in the area trigeminal nerve, such as neurovascular compression or space causing lesion. Sometimes it can be idiopathic or secondary to another medical condition. MS is one such medical condition which is known to cause TN. Cases of TN secondary to MS tend to be more refractory than other cases, with the traditional medication regimen often being ineffective, and options for surgical intervention are limited due to lack of evidence.
Design/Methods:
Patients from a single neurosurgery clinic in Boston, MA between September 2021 and December 2022 were identified. Inclusion criteria consisted of a diagnosis of TN, a diagnosis of MS, and having received percutaneous balloon rhizotomy for the treatment of TN. Data was collected; including basic demographic data, baseline characteristics of TN, and longitudinal response to percutaneous balloon rhizotomy measured by level of pain control, concomitant usage of TN medications, and adverse effects from the procedure.
Results:
Ten cases of percutaneous balloon rhizotomy used in TN secondary to MS were identified. Of the 10 cases, 8 of them reported pain relief after percutaneous balloon rhizotomy. Of those 8 patients who received pain relief, 3 of them were able to reduce the amount of medications required for control of TN. Complications to the procedure included paresthesia or allodynia in the area supplied by the trigeminal nerve, and jaw soreness.
Conclusions:
Percutaneous balloon rhizotomy is a potential treatment for refractory TN secondary to MS. Further studies should be conducted to determine its efficacy and safety as a therapeutic option.