Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
Department of Neurosurgery, University of Texas at Austin, Austin, Texas, USA.
Stereotact Funct Neurosurg. 2020;98(6):378-385. doi: 10.1159/000509315. Epub 2020 Sep 3.
The optimal treatment for medically refractory trigeminal neuralgia in multiple sclerosis (MS-TN) patients is unknown.
To compare treatment outcomes between stereotactic radiosurgery (SRS) and radiofrequency ablation (RFA).
We performed a retrospective study of MS-TN patients treated with SRS or RFA between 2002 and 2019. Outcomes included degree of pain relief, pain recurrence, and sensory changes, segregated based on initial treatment, final treatment following retreatment with the same modality, and crossover patients.
Sixty surgical cases for 42 MS-TN patients were reviewed. Initial pain freedom outcomes and rates of retreatment were similar (SRS: 30%; RFA: 42%). RFA resulted in faster onset of pain freedom (RFA: <1 week; SRS: 15 weeks; p < 0.001). SRS patients with pain relief had longer intervals to pain recurrence at 2 years (p = 0.044). Final treatment outcomes favored RFA for pain freedom/off-medication outcomes (RFA: 44%; SRS: 11%; p = 0.031), though RFA resulted in more paresthesia (RFA: 81%; SRS: 39%; p = 0.012). Both provided at least 80% of adequate pain relief. Crossover patients did not have improved pain relief.
SRS and RFA are both valid surgical options for MS-TN. Discussion with providers will need to balance patient preference with their unique treatment characteristics.
多发性硬化症（MS）相关药物难治性三叉神经痛（MS-TN）患者的最佳治疗方法尚不清楚。
比较立体定向放射外科手术（SRS）和射频消融（RFA）的治疗效果。
我们对 2002 年至 2019 年间接受 SRS 或 RFA 治疗的 MS-TN 患者进行了回顾性研究。结局包括疼痛缓解程度、疼痛复发和感觉变化，根据初始治疗、同一方法的再次治疗后的最终治疗以及交叉治疗的患者进行分组。
共回顾了 42 例 MS-TN 患者的 60 例手术病例。初始疼痛缓解率和再次治疗率相似（SRS：30%；RFA：42%）。RFA 更早缓解疼痛（RFA：<1 周；SRS：15 周；p<0.001）。SRS 患者缓解疼痛的时间间隔更长（p=0.044）。在 2 年时，最终治疗结局有利于 RFA 达到疼痛缓解/停药（RFA：44%；SRS：11%；p=0.031），但 RFA 会导致更多的感觉异常（RFA：81%；SRS：39%；p=0.012）。两种方法均能达到至少 80%的充分缓解。交叉治疗的患者疼痛缓解并无改善。
SRS 和 RFA 均是治疗 MS-TN 的有效手术方法。在与患者沟通时，需要权衡患者的偏好与治疗的独特特点。
