Neurosurgery Department, Tabriz University of Medical Sciences, Tabriz, Iran,
Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
Stereotact Funct Neurosurg. 2024;102(3):156-168. doi: 10.1159/000538516. Epub 2024 Apr 22.
Trigeminal neuralgia (TGN) poses a therapeutic challenge, particularly within the context of multiple sclerosis (MS). This study aimed to conduct a comprehensive meta-analysis and systematic review of four less-invasive treatment modalities for TGN in MS patients, namely, gamma knife radiosurgery (GKRS), glycerol rhizotomy (GR), balloon compression (BC), and radiofrequency ablation (RFA).
Single-armed meta-analyses were employed to assess the overall efficacy of each treatment, while double-armed analyses compared the efficacy between different treatment options in double-armed studies. Outcome evaluations included acute pain relief (within 1 month post-procedure), recurrence rates throughout 18 months of follow-up, and reported complication rates.
The meta-analysis revealed diverse outcomes for each intervention. GKRS demonstrated favorable outcomes, achieving a 77% success rate in alleviating pain among a pooled cohort of 863 patients, reinforcing its status as a viable therapeutic option. Additionally, GR, BC, and RFA exhibited efficacy, with success rates of 77%, 71%, and 80%, respectively, based on outcomes observed in 611, 385, and 203 patients. Double-armed analyses highlighted distinctions between the treatments, providing nuanced insights for clinical decision-making.
This meta-analysis provides a comprehensive overview of less-invasive treatments for TGN in MS patients. GKRS emerges as a leading option with comparable efficacy and fewer complications. However, the study underscores the nuanced efficacy and considerations associated with GR, BC, and RFA. The findings offer valuable insights for clinicians navigating treatment choices in this challenging patient population, considering acute pain relief, recurrence rates, and complication profiles.
三叉神经痛（TGN）在多发性硬化症（MS）患者中是一种具有挑战性的治疗疾病。本研究旨在对 4 种针对 MS 患者 TGN 的微创治疗方法（伽玛刀放射外科手术（GKRS）、甘油rhizotomy（GR）、球囊压迫（BC）和射频消融（RFA））进行全面的荟萃分析和系统评价。
采用单臂荟萃分析评估每种治疗方法的总体疗效，而双臂分析则在双臂研究中比较不同治疗方法之间的疗效。结果评估包括治疗后 1 个月内的急性疼痛缓解、18 个月随访期间的复发率以及报告的并发症发生率。
荟萃分析显示每种干预措施的结果各不相同。GKRS 在缓解疼痛方面取得了较好的结果，在 863 例患者的汇总队列中，77%的患者疼痛得到缓解，这证实了它作为一种可行的治疗选择的地位。此外，GR、BC 和 RFA 的疗效分别为 77%、71%和 80%，基于 611、385 和 203 例患者的结果。双臂分析突出了治疗之间的差异，为临床决策提供了更细致的见解。
本荟萃分析全面概述了多发性硬化症患者 TGN 的微创治疗方法。GKRS 是一种具有较高疗效且并发症较少的首选方法。然而，本研究强调了 GR、BC 和 RFA 具有不同的疗效和需要考虑的因素。这些发现为临床医生在治疗这一具有挑战性的患者群体时提供了有价值的见解，考虑到急性疼痛缓解、复发率和并发症情况。
