Efficacy of Gamma Knife radiosurgery in the management of multiple sclerosis-related trigeminal neuralgia: a systematic review and meta-analysis.
Alfio SpinaGianluca NoceraNicola BoariSandro IannacconePietro MortiniPublished in: Neurosurgical review (2021)
Trigeminal neuralgia (TN) is the most frequent craniofacial pain condition, which commonly affects patients suffering from multiple sclerosis (MS). Stereotactic radiosurgery, especially Gamma Knife radiosurgery (GKRS), represents a safe and effective treatment for TN, and it has been adopted also for MS-TN, with a lower success rate. Therefore, we aimed to analyze the outcome of GKRS for MS-TN. PubMed, Web of Science, and Google Scholar and the reference list of relevant articles were searched for GKRS in MS-TN. Two investigators independently identified the articles, assessed the study quality, and extracted the data. Endpoints of interest were initial pain responders, successful treatments at the end of follow-up, and factors influencing the outcome. Data analyses were performed using R software. Twelve articles involving 646 patients met our inclusion criteria. Pooled proportion of patients who experienced an initial response to GKRS treatment was 83% (CI 74-90%). The cumulative proportion of successful treatments at the end of follow-up was 47% (CI 33-60%). No variables were found to have a significant contribution to heterogeneity regarding the initial response outcome. The only variable significantly explaining the heterogeneity found in the proportion of successful treatments was the length of the follow-up, with a negative b coefficient (- 0.0051, p value = 0.0047). Regarding the efficacy of GKRS in MS-TN, the initial pain response rate was 83%, which dramatically decreases to 47% during follow-up. GKRS still represents a valuable option for MS-TN; however, its long-term efficacy should be always considered.
Keyphrases
- multiple sclerosis
- mass spectrometry
- ms ms
- end stage renal disease
- neuropathic pain
- chronic pain
- newly diagnosed
- chronic kidney disease
- white matter
- ejection fraction
- pain management
- prognostic factors
- peritoneal dialysis
- spinal cord injury
- public health
- electronic health record
- computed tomography
- spinal cord
- data analysis
- magnetic resonance imaging
- quality improvement
- postoperative pain
- tyrosine kinase
- patient reported
- contrast enhanced