Artikel
Pain-free interval after radiofrequency rhizotomy of the Gasserian ganglion in trigeminal neuralgia is reduced in patients with multiple sclerosis
Reduziertes schmerzfreies Intervall nach Thermokoagulation des Ganglion Gasseri zur Behandlung von Trigeminusneuralgie bei Patienten mit multipler Sklerose
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Autoren
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Tobias Greve
- Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
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Jörg-Christian Tonn
- Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
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Jan-Hinnerk Mehrkens
- Klinikum der Ludwig-Maximilians-Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
| Veröffentlicht: | 26. Juni 2020 |
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Gliederung
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Objective: In trigeminal neuralgia (TN) refractory to conservative treatment, invasive therapeutic options depend on the underlying cause. Patients with TN and multiple sclerosis (MS-TN) are usually subjected to percutaneous radiofrequency rhizotomy (RF) of the gasserian ganglion due to a different pathomechanism of pain compared to idiopathic TN (ITN). There are controversial reports on pain-free interval (PFI) after RF in patients with MS-TN compared to ITN. We systematically compared PFI in a single-center retrospective cohort of all patients receiving RF of the gasserian ganglion as primary neurosurgical therapy.
Methods: Between 01/2012 and 10/2016, 232 patients were treated with RF for TN (318 procedures). Only patients with RF as primary neurosurgical treatment option with a minimum follow-up of 36 months were included. Based on these criteria, 157 patients were included. 37 (23.6%) of those had MS-TN (18f, 57.6 ± 10.8 years, 3 patients over 75 years) and 120 (76.4%) had ITN (62f, 70.2 ± 10.7 years, 43 patients over 75 years). Median follow-up was 39.2 months [range 36.1 – 91.1 months].
Results: In the MS-TN group, 27 (73%) patients showed a recurrent TN after 25.7 ± 20.5 months [range 0.4 – 68.6 months]. In the ITN group, 44 (36.7%) patients showed a recurrent TN after a median of 20.7 ± 16.6 months [range 0.5 – 72.0 months]. In MS-TN, the proportion of pain-free patients was 67.7% at 1 year, 40.0% at 2 years and 18.9% at 3 years. In ITN patients, the proportion of pain-free patients was 90.0% at 1 year, 80.0% at 2 years and 70.0% at 3 years. Kaplan-Meier analysis demonstrated a significant difference in PFI in MS-TN compared to ITN (41.1 vs. 64.8 months, p < 0.001). Within the ITN group, no significant difference in PFI was noted between patients above and below 75 years of age.
Conclusion: In contrast to previously published literature, we report a significant reduction in PFI when patients with TN secondary to multiple sclerosis are subjected to RF compared to patients with idiopathic TN.
Figure 1 [Fig. 1]
