Glycerol rhizotomy and radiofrequency thermocoagulation for trigeminal neuralgia in multiple sclerosis

Object. Patients with trigeminal neuralgia due to multiple sclerosis (TN-MS) and idiopathic TN (ITN) who underwent glycerol rhizotomy (GR) and radiofrequency thermocoagulation with glycerol rhizotomy (RFTC-GR) were compared to investigate the effectiveness of these percutaneous ablative procedures in the TN-MS population. Methods. Between 1998 and 2010, 822 patients with typical TN were evaluated; 63 (8%) had TN-MS and 759 (92%) had ITN. Pain relief comparisons were made between 22 GR procedures in patients with TN-MS and 470 OR procedures in patients with ITN; 50 RFTC-GR procedures in patients with TN-MS and 287 RFTC-GR procedures in patients with ITN were compared. Analysis of time to recurrence included only procedures that achieved complete pain relief without medications. Results. After 15 of the OR procedures (68%) in patients with TN-MS and 315 of the procedures (67%) in those with ITN, the patients were pain free without medications (p = 0.736). After 36 of the RFTC-GR procedures (72%) in patients with TN-MS and 210 of the procedures (73%) in those with ITN, the patients were pain free without medications (p = 0.657). The difference in pain relief between OR and RFTC-GR for patients with TN-MS was not significant (p = 0.447). The median time to failure of OR was 20 months in patients with TN-MS compared with 25 months in those with ITN (p = 0.403). The median time to failure of RFTC-GR was 26 months in the TN-MS population compared with 21 months in the ITN population (p = 0.449). Patients with TN-MS experienced similar times to recurrence whether they were treated with OR or RFTC-GR (p = 0.431). Conclusions. Pain relief and durability of relief outcomes of OR and RFTC-GR were similar in patients with TN-MS and ITN, reinforcing their use as preferred treatments of TN-MS. The OR and RFTC-GR achieved comparable outcomes in patients with TN-MS, suggesting that both can be used to good effect. (http://thejns.org/doi/abs/10.3171/2012.9.JNS1226)