Berk Caglar, Constantoyannis Constantine, Honey Christopher R
Surgical Centre for Movement Disorders, Stereotactic and Functional Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada.
Can J Neurol Sci. 2003 Aug;30(3):220-3. doi: 10.1017/s0317167100002626.
Trigeminal neuralgia (TN) has a higher incidence among patients with multiple sclerosis (MS) than in the general population. This cohort of MS patients with TN presents a series of management challenges including poor tolerance of antineuralgic medications and occasional bilateral presentation. We analyzed our surgical series of MS patients presenting with TN who were treated with percutaneous radiofrequency rhizotomy to estimate the success, failure and recurrence rate of this procedure for those patients.
Surgical reports were retrospectively reviewed between the years 1996-2000. Patients with MS and TN who received a percutaneous rhizotomy during that time were included in the study and followed until the end of 2002. Data regarding age, sex, duration of MS and pain, response to medical treatment, pain distribution and surgical outcome were evaluated.
There were thirteen patients with MS and medically refractory TN treated with percutaneous radiofrequency rhizotomy. The average age at diagnosis for MS was 41 with TN beginning an average of eight years later. Following rhizotomy, complete pain relief without the need for any medication was achieved in 81% of the patients. The addition of medications resulted in pain control in the remaining patients. During a mean follow-up period of 52 months, there was a 50% recurrence rate. There were no complications related to the procedure and the associated facial numbness was well-tolerated.
Percutaneous radiofrequency rhizotomy is a safe and effective method for the treatment of TN in patients with MS. The unique susceptibility of this cohort to the side effects of antineuralgic medications may require early consideration of rhizotomy.
三叉神经痛（TN）在多发性硬化症（MS）患者中的发病率高于普通人群。这组患有TN的MS患者面临一系列管理挑战，包括抗神经痛药物耐受性差以及偶尔出现双侧症状。我们分析了接受经皮射频神经根切断术治疗的伴有TN的MS患者的手术系列，以评估该手术对这些患者的成功率、失败率和复发率。
回顾性分析1996年至2000年间的手术报告。纳入在此期间接受经皮神经根切断术的MS和TN患者，并随访至2002年底。评估有关年龄、性别、MS病程和疼痛、对药物治疗的反应、疼痛分布和手术结果的数据。
13例患有MS且药物难治性TN的患者接受了经皮射频神经根切断术。MS诊断时的平均年龄为41岁，TN平均在八年后开始出现。神经根切断术后，81%的患者实现了无需任何药物的完全疼痛缓解。其余患者通过添加药物实现了疼痛控制。在平均52个月的随访期内，复发率为50%。没有与手术相关的并发症，且相关的面部麻木耐受性良好。
经皮射频神经根切断术是治疗MS患者TN的一种安全有效的方法。该队列对抗神经痛药物副作用的独特易感性可能需要早期考虑神经根切断术。
