Skip to main content
SpringerLink
Log in

Effectiveness of gamma knife radiosurgery in the management of trigeminal neuralgia associated with multiple sclerosis: a systematic review and meta-analysis

  • Research
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

Background

Trigeminal neuralgia (TN) is a chronic condition characterized by intense facial pain akin to electric shocks, often associated with the trigeminal nerve. It can be either idiopathic or secondary, with multiple sclerosis (Ms) being a significant contributing factor. Non-responsive patients may opt for minimally invasive procedures, such as gamma knife radiosurgery (GKRS), which offers precise, non-invasive treatment and is frequently chosen as a primary approach. This meta-analysis evaluates the long-term efficacy of GKRS in TN management in Ms patients.

Methods

We conducted a focused search across various databases. Inclusion criteria encompassed studies with ≥ 30 patients using GKRS for TN in Ms, reporting pertinent clinical outcomes. Primary outcomes assessed GKRS efficacy through Barrow Neurological Institute Pain scores. Secondary outcomes encompassed bothersome numbness, facial numbness, and recurrence. Data analysis employed OpenMeta, random effect models, and odds ratios with 95% confidence intervals. Heterogeneity was assessed using I2 statistics.

Results

Fourteen studies with 752 cases of GKRS for TN were included. Regarding the outcomes, 83% of patients experienced a positive initial pain response, while the overall treatment success rate was 51%. Additionally, 19.6% of patients reported facial numbness, 4.1% experienced bothersome numbness, and 40% faced recurrence. The odds ratio for positive initial pain response was 0.83 (95% CI, 0.76–0.89), while for treatment success, it was 0.51 (95% CI, 0.379–0.639). Facial numbness had an odds ratio of 0.196 (95% CI, 0.130–0.262), bothersome numbness had an odds ratio of 0.041 (95% CI, 0.013–0.069), and recurrence had an odds ratio of 0.403 (95% CI, 0.254–0.551).

Conclusions

In conclusion, treating trigeminal neuralgia in multiple sclerosis patients remains challenging. GKRS shows promise, but customized treatment approaches tailored to individual patient characteristics are urgently needed to address the unique challenges of this condition.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Data availability

The authors confirm that the data supporting the findings of this study are available within the article.

References

  1. Jones MR, Urits I, Ehrhardt KP, Cefalu JN, Kendrick JB, Park DJ et al (2019) A comprehensive review of trigeminal neuralgia. Curr Pain Headache Rep 23(10):74

    Article  PubMed  Google Scholar 

  2. Leduc W, Mathieu D, Adam E, Ferreira R, Iorio-Morin C (2023) Gamma knife stereotactic radiosurgery for trigeminal neuralgia secondary to multiple sclerosis: a case-control study. Neurosurgery 93(2):453–461

    Article  PubMed  Google Scholar 

  3. Franzini A, Tropeano MP, Olei S, De Robertis M, Rossini Z, Attuati L et al (2021) Gamma knife radiosurgery for the treatment of trigeminal neuralgia in patients with multiple sclerosis: a single-center retrospective study and literature review. World Neurosurg 149:e92–e100

    Article  PubMed  Google Scholar 

  4. Gambeta E, Chichorro JG, Zamponi GW (2020) Trigeminal neuralgia: An overview from pathophysiology to pharmacological treatments. Mol Pain 16:1744806920901890

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Maarbjerg S, Di Stefano G, Bendtsen L, Cruccu G (2017) Trigeminal neuralgia - diagnosis and treatment. Cephalalgia 37(7):648–657

    Article  PubMed  Google Scholar 

  6. Truini A (2015) Trigeminal neuralgia. J Headache pain 16(Suppl 1):A42

    Article  PubMed  Google Scholar 

  7. Maarbjerg S, Sørensen MT, Gozalov A, Bendtsen L, Olesen J (2015) Field-testing of the ICHD-3 beta diagnostic criteria for classical trigeminal neuralgia. Cephalalgia 35(4):291–300

    Article  PubMed  Google Scholar 

  8. Ömerhoca S, Akkaş SY, İçen NK (2018) Multiple sclerosis: diagnosis and differential diagnosis. Noro Psikiyatr Ars 55(Suppl 1):S1–s9

    PubMed  PubMed Central  Google Scholar 

  9. Alvarez-Pinzon AM, Wolf AL, Swedberg HN, Barkley KA, Cucalon J, Curia L et al (2017) Comparison of percutaneous retrogasserian balloon compression and gamma knife radiosurgery for the treatment of trigeminal neuralgia in multiple sclerosis. World Neurosurg 97:590–594

    Article  PubMed  Google Scholar 

  10. Rana MH, Khan AAG, Khalid I, Ishfaq M, Javali MA, Baig FAH et al (2023) Therapeutic approach for trigeminal neuralgia: a systematic review. Biomedicines 11(10):2606

    Article  PubMed  PubMed Central  Google Scholar 

  11. Montano N, Conforti G, Di Bonaventura R, Meglio M, Fernandez E, Papacci F (2015) Advances in diagnosis and treatment of trigeminal neuralgia. Ther Clin Risk Manag 11:289–299

    Article  PubMed  PubMed Central  Google Scholar 

  12. Patra DP, Savardekar AR, Dossani RH, Narayan V, Mohammed N, Nanda A (2018) Repeat Gamma Knife radiosurgery versus microvascular decompression following failure of GKRS in trigeminal neuralgia: a systematic review and meta-analysis. J Neurosurg 131(4):1197–1206. https://doi.org/10.3171/2018.5.JNS18583

  13. Spina A, Nocera G, Boari N, Iannaccone S, Mortini P (2021) Efficacy of Gamma Knife radiosurgery in the management of multiple sclerosis-related trigeminal neuralgia: a systematic review and meta-analysis. Neurosurg Rev 44(6):3069–3077

    Article  PubMed  Google Scholar 

  14. Andersen ASS, Heinskou TB, Rochat P, Springborg JB, Noory N, Smilkov EA et al (2022) Microvascular decompression in trigeminal neuralgia - a prospective study of 115 patients. J Headache Pain 23(1):145

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Przybylowski CJ, Cole TS, Baranoski JF, Little AS, Smith KA, Shetter AG (2019) Radiosurgery for multiple sclerosis–related trigeminal neuralgia: retrospective review of long-term outcomes. J Neurosurg JNS 131(5):1583–1590

    Article  Google Scholar 

  16. Huang E, Teh BS, Zeck O, Woo SY, Lu HH, Chiu JK et al (2003) Gamma knife radiosurgery for treatment of trigeminal neuralgia in multiple sclerosis patients. Stereotact Funct Neurosurg 79(1):44–50

    Article  Google Scholar 

  17. Rogers CL, Shetter AG, Ponce FA, Fiedler JA, Smith KA, Speiser BL (2002) Gamma knife radiosurgery for trigeminal neuralgia associated with multiple sclerosis. J Neurosurg 97(5 Suppl):529–532

    Article  PubMed  Google Scholar 

  18. Zorro O, Lobato-Polo J, Kano H, Flickinger JC, Lunsford LD, Kondziolka D (2009) Gamma knife radiosurgery for multiple sclerosis-related trigeminal neuralgia. Neurology 73(14):1149–1154

    Article  CAS  PubMed  Google Scholar 

  19. Mathieu D, Effendi K, Blanchard J, Séguin M (2012) Comparative study of Gamma Knife surgery and percutaneous retrogasserian glycerol rhizotomy for trigeminal neuralgia in patients with multiple sclerosis. J Neurosurg 117(Suppl):175–180

    Article  PubMed  Google Scholar 

  20. Mohammad-Mohammadi A, Recinos PF, Lee JH, Elson P, Barnett GH (2013) Surgical outcomes of trigeminal neuralgia in patients with multiple sclerosis. Neurosurgery 73(6):941–950 discussion 50

    Article  PubMed  Google Scholar 

  21. Tuleasca C, Carron R, Resseguier N, Donnet A, Roussel P, Gaudart J et al (2014) Multiple sclerosis-related trigeminal neuralgia: a prospective series of 43 patients treated with gamma knife surgery with more than one year of follow-up. Stereotact Funct Neurosurg 92(4):203–210

    Article  PubMed  Google Scholar 

  22. Weller M, Marshall K, Lovato JF, Bourland JD, deGuzman AF, Munley MT et al (2013) Single-institution retrospective series of gamma knife radiosurgery in the treatment of multiple sclerosis-related trigeminal neuralgia: factors that predict efficacy. Stereotact Funct Neurosurg 92(1):53–58

    Article  PubMed  Google Scholar 

  23. Krishnan S, Bigder M, Kaufmann AM (2018) Long-term follow-up of multimodality treatment for multiple sclerosis-related trigeminal neuralgia. Acta Neurochirurgica 160(1):135–144

    Article  PubMed  Google Scholar 

  24. Li CMF, Hung PS-P, Chu PP, Tohyama S, Hodaie M (2020) Trigeminal neuralgia associated with multiple sclerosis: a multimodal assessment of brainstem plaques and response to Gamma Knife radiosurgery. Mult Scler J 26(14):1877–1888

    Article  Google Scholar 

  25. Xu Z, Mathieu D, Heroux F, Abbassy M, Barnett G, Mohammadi AM et al (2019) Stereotactic radiosurgery for trigeminal neuralgia in patients with multiple sclerosis: a multicenter study. Neurosurgery 84(2):499–505

    Article  PubMed  Google Scholar 

  26. Solaro C, Trabucco E, Messmer UM (2013) Pain and multiple sclerosis: pathophysiology and treatment. Curr Neurol Neurosci Rep 13(1):320

    Article  PubMed  Google Scholar 

  27. Cruccu G, Biasiotta A, Galeotti F, Iannetti GD, Truini A, Gronseth G (2006) Diagnostic accuracy of trigeminal reflex testing in trigeminal neuralgia. Neurology 66(1):139–141

    Article  CAS  PubMed  Google Scholar 

  28. Zakrzewska JM, Wu J, Brathwaite TS (2018) A systematic review of the management of trigeminal neuralgia in patients with multiple sclerosis. World Neurosurg 111:291–306

    Article  PubMed  Google Scholar 

  29. Montano N, Papacci F, Cioni B, Di Bonaventura R, Meglio M (2013) What is the best treatment of drug-resistant trigeminal neuralgia in patients affected by multiple sclerosis? A literature analysis of surgical procedures. Clin Neurol Neurosurg 115(5):567–572

    Article  PubMed  Google Scholar 

  30. Song A, Shi W, Lo SS, Ellenbogen R, Ko AL (2019) Commentary: gamma knife radiosurgery for multiple sclerosis-associated trigeminal neuralgia. Neurosurgery 85(5):E941–E9E2

    Article  PubMed  Google Scholar 

  31. Spina A, Mortini P, Alemanno F, Houdayer E, Iannaccone S (2017) Trigeminal neuralgia: toward a multimodal approach. World Neurosurg 103:220–230

    Article  PubMed  Google Scholar 

  32. Wolf A, Kondziolka D (2016) Gamma knife surgery in trigeminal neuralgia. Neurosurg Clin N Am 27(3):297–304

    Article  PubMed  Google Scholar 

  33. Helis CA, McTyre E, Munley MT, Bourland JD, Lucas JTJ, Cramer CK et al (2019) Gamma knife radiosurgery for multiple sclerosis-associated trigeminal neuralgia. Neurosurgery 85(5):E933–E9E9

    Article  PubMed  PubMed Central  Google Scholar 

  34. Holland MT, Teferi N, Noeller J, Swenson A, Smith M, Buatti J et al (2017) Stereotactic radio surgery and radio frequency rhizotomy for trigeminal neuralgia in multiple sclerosis: a single institution experience. Clin Neurol Neurosurg 162:80–84

    Article  PubMed  Google Scholar 

  35. Iannaccone S, Spina A, Alemanno F, Della Rosa PA, Houdayer E, Raggi A et al (2019) Uncertain effectiveness of prophylactic anticonvulsive medication in predicting cognitive outcome of neurosurgical patients. World Neurosurgery 127:e692–e6e6

    Article  PubMed  Google Scholar 

  36. Lee Anthony T, Raygor Kunal P, Elefant F, Ward Mariann M, Wang Doris D, Barbaro Nicholas M et al (2020) Comparison of stereotactic radiosurgery and radiofrequency ablation for trigeminal neuralgia in multiple sclerosis patients. Stereotact Funct Neurosurg 98(6):378–385

    Article  CAS  PubMed  Google Scholar 

  37. Lee C-C, Chen C-J, Chong ST, Hung S-C, Yang H-C, Lin CJ et al (2018) Early stereotactic radiosurgery for medically refractory trigeminal neuralgia. World Neurosurgery 112:e569–ee75

    Article  PubMed  Google Scholar 

  38. Mousavi SH, Niranjan A, Huang MJ, Laghari FJ, Shin SS, Mindlin JL et al (2015) Early radiosurgery provides superior pain relief for trigeminal neuralgia patients. Neurology 85(24):2159–2165

    Article  PubMed  Google Scholar 

  39. Vulpe H, Wang TJC (2019) Commentary: Gamma knife radiosurgery for multiple sclerosis-associated trigeminal neuralgia. Neurosurgery 85(5):E940

    Article  PubMed  Google Scholar 

  40. Spina A, Boari N, Gagliardi F, Bailo M, Morselli C, Iannaccone S et al (2019) The emerging role of gamma knife radiosurgery in the management of glossopharyngeal neuralgia. Neurosurg Rev 42(1):31–38

    Article  PubMed  Google Scholar 

  41. Tuleasca C, Paddick I, Hopewell JW, Jones B, Millar WT, Hamdi H et al (2020) Establishment of a Therapeutic ratio for gamma knife radiosurgery of trigeminal neuralgia: the critical importance of biologically effective dose versus physical dose. World Neurosurg 134:e204–ee13

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Liaquat National Hospital & Medical College, Stadium Road, Karachi, 74800, Pakistan

    Syed Muhmmad Sinaan Ali, Syed Ahsan Ali Jafri & Sara Khalil

  2. Department of Medicine, Jinnah Sindh Medical University, Iqbal Shaheed Rd, Karachi, 75510, Pakistan

    Muhammad Ashir Shafique, Muhammad Saqlain Mustafa, Hareer Fatima & Hussain Sohail Rangwala

Authors
  1. Syed Muhmmad Sinaan Ali
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Muhammad Ashir Shafique
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Muhammad Saqlain Mustafa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Syed Ahsan Ali Jafri
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sara Khalil
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hareer Fatima
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hussain Sohail Rangwala
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

The conceptualization was done by MAS. The literature and drafting of the manuscript were conducted by MAS, MSM, HSR, HF, SMSA, SAAJ, and SK. The editing and supervision were performed by HSR and HF. All authors have read and agreed to the final version of the manuscript.

Corresponding author

Correspondence to Hussain Sohail Rangwala.

Ethics declarations

Ethics approval and consent to participate

Not applicable

Consent for publication

Not applicable

Competing interests

The authors declare no potential conflicts of interest concerning the research, authorship, and/or publication of this article.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ali, S.M.S., Shafique, M.A., Mustafa, M.S. et al. Effectiveness of gamma knife radiosurgery in the management of trigeminal neuralgia associated with multiple sclerosis: a systematic review and meta-analysis. Neurosurg Rev 47, 12 (2024). https://doi.org/10.1007/s10143-023-02246-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10143-023-02246-3

Keywords

Search

Navigation