---
title: "Surgical treatment outcomes for trigeminal neuralgia in multiple sclerosis: systematic review"
id: "pubmed-42839184"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42839184"
content_type: "clinical_feed_article"
specialty: "Neurology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42839184/"
doi: "10.1007/s10143-026-04494-5"
published_at: "2026-10-07T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Surgical treatment outcomes for trigeminal neuralgia in multiple sclerosis: systematic review
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42839184
- **Specialty:** [Neurology](https://medichelpline.com/clinical-feed/neurology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42839184/)
- **DOI:** [10.1007/s10143-026-04494-5](https://doi.org/10.1007%2Fs10143-026-04494-5)
- **Published At:** 2026-10-07T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Trigeminal neuralgia occurs in approximately **3%** of people with **multiple sclerosis (MS)**, a much higher rate than in the general population, and is often resistant to medication. - This systematic review (Embase, PubMed, Scopus; Jan 2000–Apr 2026) included 32 studies comprising **1,617 patients**, selecting studies that reported pain outcomes using the **Barrow Neurological Institute (BNI) Pain Scale**. - Risk of bias in included studies was assessed with the **Newcastle-Ottawa Scale**; narrative synthesis followed PRISMA guidance. - **Microvascular decompression (MVD)** produced durable pain relief when **neurovascular conflict** was demonstrable, but carried higher rates of serious complications, including one reported fatality; diagnostic uncertainty about MS-driven pain complicates case selection. - **Partial sensory rhizotomy (PSR)** showed high initial success (95.3–100%) and durable relief (reported recurrence intervals 20.1–79 months) but included some severe trigeminal dysfunction cases such as **anaesthesia dolorosa** (n = 3; reported 7.5% in that series). - **Percutaneous ablative procedures** achieved initial success ranging from 58% to 100% and had a generally mild complication profile; durability was variable with recurrence typically occurring between 8 and 60 months. - **Gamma Knife radiosurgery (GKRS)** produced initial pain control ranging from 52.7% to 97.3%; complications were mostly mild but durability was suboptimal with recurrence reported from 7.4 to 74.5 months; different dose thresholds ( 80 Gy) were not associated with significant differences in pain control across studies. - A 2025 study of **arachnoid-trigeminal nerve release** provided preliminary favorable results (75% achieved BNI I at final follow-up), but data are limited. - Overall, GKRS and percutaneous procedures offer **well-tolerated** options with similar outcomes to primary trigeminal neuralgia cohorts regardless of plaque burden; PSR may be particularly effective and durable in refractory MS-associated cases without neurovascular conflict. - MVD may provide long-term durability when neurovascular conflict exists but requires cautious selection due to increased procedural risk and diagnostic uncertainty in MS patients. - The authors recommend **high-resolution preoperative imaging** to guide personalised surgical choice and call for prospective studies and standardized outcome reporting in this population.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Queen Square Institute of Neurology, University College London, London, UK. anish.kalyana.22@ucl.ac.uk. * 2 Queen Square Institute of Neurology, University College London, London, UK. * 3 National Hospital for Neurology and Neurosurgery, London, UK. * PMID: **42839184** * DOI: [ 10.1007/s10143-026-04494-5 ](https://doi.org/10.1007/s10143-026-04494-5) Item in Clipboard Review # The efficacy of surgical interventions for trigeminal neuralgia in multiple sclerosis: A systematic review Anish Kalyana et al. Neurosurg Rev. 2026. Show details Display options Display options Format Abstract PubMed PMID Neurosurg Rev Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Neurosurg+Rev%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Neurosurg+Rev%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42839184/) . 2026 Oct 7;49(1):600. doi: 10.1007/s10143-026-04494-5. ### Authors [Anish Kalyana](https://pubmed.ncbi.nlm.nih.gov/?term=Kalyana+A&cauthor_id=42839184)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42839184/#short-view-affiliation-1 "Queen Square Institute of Neurology, University College London, London, UK. anish.kalyana.22@ucl.ac.uk."), [Daniel Coles](https://pubmed.ncbi.nlm.nih.gov/?term=Coles+D&cauthor_id=42839184)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42839184/#short-view-affiliation-2 "Queen Square Institute of Neurology, University College London, London, UK."), [Sameer Khalil](https://pubmed.ncbi.nlm.nih.gov/?term=Khalil+S&cauthor_id=42839184)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42839184/#short-view-affiliation-2 "Queen Square Institute of Neurology, University College London, London, UK."), [Mohammad Mahmud](https://pubmed.ncbi.nlm.nih.gov/?term=Mahmud+M&cauthor_id=42839184)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42839184/#short-view-affiliation-2 "Queen Square Institute of Neurology, University College London, London, UK.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42839184/#short-view-affiliation-3 "National Hospital for Neurology and Neurosurgery, London, UK."), [Roshni Beeharry](https://pubmed.ncbi.nlm.nih.gov/?term=Beeharry+R&cauthor_id=42839184)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42839184/#short-view-affiliation-2 "Queen Square Institute of Neurology, University College London, London, UK."), [Sanjay Cheema](https://pubmed.ncbi.nlm.nih.gov/?term=Cheema+S&cauthor_id=42839184)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42839184/#short-view-affiliation-3 "National Hospital for Neurology and Neurosurgery, London, UK."), [Anouk Borg](https://pubmed.ncbi.nlm.nih.gov/?term=Borg+A&cauthor_id=42839184)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42839184/#short-view-affiliation-3 "National Hospital for Neurology and Neurosurgery, London, UK."), [Tim M Young](https://pubmed.ncbi.nlm.nih.gov/?term=Young+TM&cauthor_id=42839184)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42839184/#short-view-affiliation-2 "Queen Square Institute of Neurology, University College London, London, UK.") ### Affiliations * 1 Queen Square Institute of Neurology, University College London, London, UK. anish.kalyana.22@ucl.ac.uk. * 2 Queen Square Institute of Neurology, University College London, London, UK. * 3 National Hospital for Neurology and Neurosurgery, London, UK. * PMID: **42839184** * DOI: [ 10.1007/s10143-026-04494-5 ](https://doi.org/10.1007/s10143-026-04494-5) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract Trigeminal neuralgia affects approximately 3% of patients with multiple sclerosis - a far higher prevalence than in the general population. The associated pain often proves refractory to medication, prompting consideration of neurosurgical intervention. The variable efficacy, tolerability, and durability of available procedures, compounded by factors such as multiple sclerosis subtype and neuroimaging findings, require evidence to guide personalised surgical decision-making. This systematic review evaluates surgical interventions for trigeminal neuralgia in multiple sclerosis, analysing how patient and disease-specific variables influence outcomes. A systematic review with narrative synthesis was performed. Following PRISMA guidelines, Embase, PubMed, and Scopus were searched (January 2000 - April 2026). Studies assessing pain relief from surgical procedures for trigeminal neuralgia in multiple sclerosis using the Barrow Neurological Institute Pain Scale were included. Risk of bias was assessed using the Newcastle-Ottawa Scale. Thirty-two studies, encompassing 1617 patients, met the inclusion criteria. Microvascular decompression in cases with demonstrable neurovascular conflict provided durable outcomes offset by higher risks of serious complications (including one fatality), despite inherent diagnostic uncertainty regarding whether pain was specifically driven by multiple sclerosis. Partial sensory rhizotomy displayed favourable pain relief (initial success range: 95.3-100%) and durability (recurrence ranging from 20.1 to 79 months). Whilst some studies noted a lack of major complications, some cases of severe trigeminal dysfunction including anaesthesia dolorosa were reported (n = 3; 7.5%). Percutaneous ablative procedures (initial success ranging from 58 to 100%) and gamma knife radiosurgery (initial success ranging from 52.7 to 97.3%) achieved comparable pain control rates to classical trigeminal neuralgia cohorts. They also featured a mild complication profile, though durability was suboptimal (recurrence ranging from 7.4 to 74.5 months for gamma knife radiosurgery and 8-60 months for percutaneous procedures) and repeat procedures were typically tolerable. Differing gamma knife radiosurgery dosages ( 80 Gy) were not associated with significant differences in pain control. Preliminary outcomes of arachnoid-trigeminal nerve release from a 2025 study highlighted promising results with 75% of patients achieving Barrow Neurological Institute Pain Scale I at final follow-up. Gamma knife radiosurgery and percutaneous ablative procedures represent well-tolerated surgical options with comparable outcomes to primary trigeminal neuralgia cohorts regardless of plaque burden. Partial sensory rhizotomy demonstrated notable efficacy and durability in refractory multiple sclerosis-associated trigeminal neuralgia, particularly in the absence of neurovascular conflict, and warrants earlier consideration in the surgical pathway. Microvascular decompression may offer long-term durability where neurovascular conflict is demonstrated. However, its higher procedural risk and the diagnostic uncertainty inherent in multiple sclerosis-associated trigeminal neuralgia cases with concurrent neurovascular conflict necessitate cautious patient selection. High-resolution preoperative imaging is therefore recommended to guide personalised modality selection. Prospective studies are needed to further validate surgical decision-making and establish standardised outcome reporting in this population. **Keywords:** Gamma knife radiosurgery; Microvascular decompression; Multiple sclerosis; Percutaneous ablative procedures; Secondary trigeminal neuralgia; Trigeminal neuralgia. © 2026. The Author(s). [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declarations. Ethics approval and consent to participate and Publish: Not Applicable. Consent for publication: Not Applicable. Competing interests: The authors declare no competing interests. ## References 1. 1. Mueller D, Obermann M, Yoon MS, Poitz F, Hansen N, Slomke MA et al (2011) Prevalence of trigeminal neuralgia and persistent idiopathic facial pain: a population-based study. Cephalalgia 31(15):1542–1548. - [DOI](https://doi.org/10.1177/0333102411424619) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/21960648/) 2. 1. Cruccu G, Biasiotta A, Di Rezze S, Fiorelli M, Galeotti F, Innocenti P et al (2009) Trigeminal neuralgia and pain related to multiple sclerosis. Pain 143(3):186–191. - [DOI](https://doi.org/10.1016/j.pain.2008.12.026) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/19171430/) 3. 1. Headache Classification Committee of the International Headache Society (IHS) (2018) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 38(1):1–211. - [DOI](https://doi.org/10.1177/0333102417738202) 4. 1. Di Stefano G, Maarbjerg S, Truini A (2019) Trigeminal neuralgia secondary to multiple sclerosis: from the clinical picture to the treatment options. J Headache Pain 20(1):20. - [DOI](https://doi.org/10.1186/s10194-019-0969-0) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/30782116/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/6734488/) 5. 1. Godazandeh K, Martinez Sosa S, Wu J, Zakrzewska JM (2019) Trigeminal neuralgia: Comparison of characteristics and impact in patients with or without multiple sclerosis. Mult Scler Relat Disord 34:41–46. - [DOI](https://doi.org/10.1016/j.msard.2019.06.015) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/31228715/) Show all 125 references ## Publication types * Systematic Review Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Systematic+Review%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Systematic+Review) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42839184/) * Review Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Review%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Review) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42839184/) ## MeSH terms * Humans Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Humans%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Humans) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42839184/) * Microvascular Decompression Surgery / methods Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Microvascular+Decompression+Surgery%2Fmethods%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Microvascular+Decompression+Surgery) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42839184/) * Multiple Sclerosis* / complications Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Multiple+Sclerosis%2Fcomplications%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Multiple+Sclerosis) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42839184/) * Multiple Sclerosis* / surgery Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Multiple+Sclerosis%2Fsurgery%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Multiple+Sclerosis) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42839184/) * Neurosurgical Procedures* / methods Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Neurosurgical+Procedures%2Fmethods%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Neurosurgical+Procedures) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42839184/) * Radiosurgery / methods Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/
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