Surgery for Facial Pain

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Mohammad-Mohammadi A, Recinos PF, Lee JH, Elson P, Barnett GH.Surgical Outcomes of Trigeminal Neuralgia in Patients with Multiple Sclerosis. Neurosurgery. 2013 Aug. [Epub ahead of print]

BACKGROUND:Trigeminal neuralgia (TN) is relatively frequent in multiple sclerosis (MS) patients and can be extremely disabling. Surgical interventions are less effective for treatment of MS-related TN compared with classic TN, and higher recurrence rates are observed.
OBJECTIVE: To evaluate initial pain-free response (IPFR), duration of pain-free intervals (PFI), and factors predictive of outcome in different surgical modalities used to treat MS-related TN.
METHODS:A total of 96 MS patients underwent 277 procedures (range: 1-11 procedures/patient) to treat TN at our institution from 1995-2011. Of these, 89 percutaneous retrogasserian glycerol rhizotomies (PRGR), 82 balloon compressions (BC), 52 stereotactic radiosurgeries (SRS), 28 peripheral neurectomies, 15 percutaneous radiofrequency rhizotomies, and 10 microvascular decompressions were performed as upfront or repeat treatments.
RESULTS: Bilateral pain was observed in 10% of patients during the course of disease. During the follow-up period (median of 5.7 years), recurrence of symptoms occurred in 66% of patients and 181 procedures were performed for symptom recurrence. As an initial procedure, BC had the highest IPFR (95%, p=0.006) and median PFI (28 months, p=0.05) followed by PRGR (IPFR: 74%, p=0.04 and median PFI: 9 months, p=0.05). In general, repeat procedures had lower effectiveness compared to initial procedures, with no statistically significant difference seen across the various treatment modalities.
CONCLUSION: Treatment failure occurs in most of the MS-related TN patients independent of the type of treatment.
Worth bearing in mind modern medicine does not hold all the answers

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