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Efficacy of Gamma Knife radiosurgery in the management of multiple sclerosis-related trigeminal neuralgia: a systematic review and meta-analysis

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Abstract

Trigeminal neuralgia (TN) is the most frequent craniofacial pain condition, which commonly affects patients suffering from multiple sclerosis (MS). Stereotactic radiosurgery, especially Gamma Knife radiosurgery (GKRS), represents a safe and effective treatment for TN, and it has been adopted also for MS-TN, with a lower success rate. Therefore, we aimed to analyze the outcome of GKRS for MS-TN. PubMed, Web of Science, and Google Scholar and the reference list of relevant articles were searched for GKRS in MS-TN. Two investigators independently identified the articles, assessed the study quality, and extracted the data. Endpoints of interest were initial pain responders, successful treatments at the end of follow-up, and factors influencing the outcome. Data analyses were performed using R software. Twelve articles involving 646 patients met our inclusion criteria. Pooled proportion of patients who experienced an initial response to GKRS treatment was 83% (CI 74–90%). The cumulative proportion of successful treatments at the end of follow-up was 47% (CI 33–60%). No variables were found to have a significant contribution to heterogeneity regarding the initial response outcome. The only variable significantly explaining the heterogeneity found in the proportion of successful treatments was the length of the follow-up, with a negative b coefficient (− 0.0051, p value = 0.0047). Regarding the efficacy of GKRS in MS-TN, the initial pain response rate was 83%, which dramatically decreases to 47% during follow-up. GKRS still represents a valuable option for MS-TN; however, its long-term efficacy should be always considered.

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  1. Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy

    Alfio Spina, Gianluca Nocera, Nicola Boari & Pietro Mortini

  2. Department of Rehabilitation and Functional Recovery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy

    Sandro Iannaccone

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  1. Alfio Spina
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  2. Gianluca Nocera
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Conceptualization: Alfio Spina. Methodology, formal analysis, and investigation: Alfio Spina, Gianluca Nocera. Writing—original draft preparation: Alfio Spina, Gianluca Nocera, Nicola Boari. Writing—review and editing: all authors. Supervision: Sandro Iannaccone, Pietro Mortini

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Spina, A., Nocera, G., Boari, N. et al. Efficacy of Gamma Knife radiosurgery in the management of multiple sclerosis-related trigeminal neuralgia: a systematic review and meta-analysis. Neurosurg Rev 44, 3069–3077 (2021). https://doi.org/10.1007/s10143-021-01507-3

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