Surgical and interventional approaches to multiple sclerosis-related trigeminal neuralgia

Abstract

Objective: To analyze the available evidence on surgical and interventional approaches for the treatment of trigeminal neuralgia associated with multiple sclerosis, with emphasis on their indications, effectiveness, recurrence, and limitations. Literature review: Trigeminal neuralgia secondary to multiple sclerosis represents a major therapeutic challenge, particularly in cases refractory to pharmacological treatment. The main modalities described in the literature include microvascular decompression, percutaneous balloon compression, radiofrequency thermocoagulation, stereotactic radiosurgery, partial sensory rhizotomy, glycerol rhizolysis, internal neurolysis, and botulinum toxin type A injection. The studies analyzed showed that these interventions can provide significant pain relief in selected patients. However, outcomes vary according to the technique used, the patient’s clinical profile, and the length of follow-up, with pain recurrence and the need for retreatment being relatively frequent. Final considerations: Surgical and interventional approaches are relevant alternatives for patients with trigeminal neuralgia associated with multiple sclerosis that is refractory to medical treatment, provided that treatment selection is individualized. However, the predominance of retrospective studies, small sample sizes, methodological heterogeneity, and lack of robust comparative studies limits the establishment of definitive recommendations.