Tag: Partial sensory rhizotomy

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The utility of partial sensory rhizotomy and adjunct procedures in the surgical management of trigeminal neuralgia secondary to multiple sclerosis

J Neurosurg 144:1145–1153, 2026

This clinical study evaluates long-term outcomes of partial sensory rhizotomy (PSR) for trigeminal neuralgia (TN) secondary to multiple sclerosis (MS), comparing PSR alone, redo PSR, and PSR combined with microvascular decompression (MVD) or internal neurolysis (IN). Retrospective analysis of 37 procedures in 30 patients shows high immediate pain relief (89.2%), mean recurrence at 1.64 years, and variable durability across groups.

At final follow-up, combination therapy (PSR+MVD or PSR+IN) trended toward superior sustained pain freedom without increased complications, while first PSR commonly required additional interventions. The authors conclude PSR is an effective salvage option and suggest adjunctive MVD or IN may improve long-term outcomes, recommending prospective validation.

Objective Evaluate long-term outcomes of partial sensory rhizotomy (PSR) alone versus PSR combined with microvascular decompression (MVD) or internal neurolysis (IN) for trigeminal neuralgia secondary to multiple sclerosis.

Methods Retrospective review of PSR cases (2012–2023) grouped as first PSR, redo PSR, PSR+MVD, and PSR+IN; assessed pain outcomes, recurrence, and complications.

Cohort 30 patients underwent 37 procedures; 89.2% of procedures followed at least one prior ipsilateral TN procedure.

Immediate outcomes 89.2% achieved immediate postoperative pain relief (pain free with or without medication), with no significant differences between procedure groups.

Durability Pain recurred on average at 1.64 ± 1.71 years after the procedure, with no significant differences among groups.

Final follow-up pain freedom At mean 3.14 ± 2.58 years follow-up, 75% of PSR+MVD and 100% of PSR+IN cases were pain free; 52.3% of first PSR cases required additional procedures.

Complications Overall complication rate was 29.7% with no significant differences between groups; ipsilateral facial numbness was common (59.5%) and treated as an expected outcome rather than a complication.

Conclusion PSR functions effectively as a salvage option for MS-related TN, and adding MVD or IN may improve long-term pain relief without increasing complication rates.

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Partial sensory rhizotomy in therapy‑refractory and recurrent trigeminal neuralgia

Acta Neurochirurgica (2026) 168:42

This single-center retrospective analysis reports outcomes of partial sensory rhizotomy (PSR) for therapy-refractory or recurrent trigeminal neuralgia (TN) in 48 patients treated between 2004 and 2023. The study details patient selection, surgical technique, and perioperative findings, noting immediate pain relief in most patients, variable hypesthesia, and acceptable complication rates without permanent deficits.

Long-term follow-up (mean 38 months) found 65% pain-free without medication and 95% overall satisfaction (BNI 1–3), including a substantive subset with multiple sclerosis; recurrence occurred in 27% with some successfully re-operated. The authors conclude PSR is a viable option for selected refractory or recurrent TN patients, emphasizing informed consent about unpredictable sensory deficits

Partial Sensory Rhizotomy (PSR) Role: PSR is a surgical option for therapy-refractory or recurrent trigeminal neuralgia (TN), especially in patients without neurovascular conflict or those who failed previous microvascular decompression (MVD) or other interventions.

Efficacy: PSR provided immediate total pain relief in 87.5% (42/48) of patients; long-term, 72.1% (31/43) had complete or partial pain relief without medication, and 23.3% were satisfied with ongoing medication.

Indications: PSR is particularly relevant for patients with multiple sclerosis (MS)-related TN and those without a clear neurovascular conflict, as well as for those not responding to or preferring to avoid repeated percutaneous or radiosurgical procedures.

Complications: Postoperative hypesthesia is expected and occurred in 77.1% of patients, but was generally well tolerated; no cases of anesthesia dolorosa or corneal anesthesia were observed. Other complications (e.g., CSF fistula, transient hearing impairment) were rare and resolved with treatment.

Recurrence: The observed recurrence rate after PSR was 27.1%, consistent with previously reported rates (10–49% over five years), and repeat PSR was effective in patients with recurrent pain.

Comparison with Other Treatments: While MVD is preferred when neurovascular conflict is present, PSR offers comparable long-term pain relief in selected patients, but with a higher risk of sensory deficits. Combined MVD+PSR does not improve long-term outcomes if no vascular conflict exists.

Patient Satisfaction: Overall, 95% of patients reported meaningful improvement and satisfaction with PSR, despite sensory deficits, when adequately counseled preoperatively.

Recommendation: PSR should be considered and discussed as a viable surgical alternative for therapy-refractory or recurrent TN, particularly in MS patients and those not suitable for or preferring to avoid other invasive procedures.

 

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Microsurgical rhizotomy for trigeminal neuralgia in MS patients

J Neurosurg 130:1877–1888, 2019

Patients with multiple sclerosis (MS)–associated trigeminal neuralgia (TN) have higher recurrence and retreatment rates than non-MS patients. The optimal management strategy and role for microsurgical rhizotomy (MSR) for MS-TN remains to be determined. The aim of this study was to report time to treatment failure (TTF) and pain scores following MSR compared to percutaneous and Gamma Knife procedures.

METHODS Time to treatment failure was analyzed after MSR (n = 14) versus prior procedures (n = 53) among MS-TN patients. Kaplan-Meier curves and log-rank test were utilized to compare TTF after MSR versus prior procedures using the same cohort of patients as their own control group. Subsequent analysis compared TTF after MSR to TTF after 93 other procedures among a second cohort of 18 MS-TN patients not undergoing MSR. BNI pain scores were compared between MSR and other procedures among the MS-TN cohort using a chi-square test.

RESULTS TTF was significantly longer after MSR than after other procedures in the MSR cohort (median TTF 79 vs 10 months, respectively, p < 0.0001). Similarly, TTF was longer after MSR than after prior procedures in the non-MSR cohort (median TTF 79 vs 13 months, respectively, p < 0.001). MSR resulted in a higher proportion of excellent pain scores when compared to other procedures in the non-MSR cohort (77% vs 29%, p < 0.001). Probability of treatment survival was higher after MSR than after other procedures at all time points (3, 6, 12, 24, 36, and 48 months). There were no deaths or major complications after MSR.

CONCLUSIONS TTF was significantly longer following MSR compared to prior procedures in MS-TN patients. Additionally, a higher proportion of patients achieved excellent BNI pain scores after MSR.

 

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Long-term follow-up of multimodality treatment for multiple sclerosis-related trigeminal neuralgia

Acta Neurochir (2018) 160:135–144

The treatment for multiple sclerosis-related trigeminal neuralgia (MS-TN) is less efficacious and associated with higher recurrence rates than classical TN. No consensus has been reached in the literature on the choice procedure for MS-TN patients. The aim of this study was to assess the incidence and surgical outcomes of medically refractory MS-TN.

Methods Patient records were retrospectively reviewed for all Manitobans undergoing first procedure for medically refractory MS-TN between 2000 and 2014. Subsequent procedures were then recorded and analyzed in this subgroup of patients. The primary outcome measure was time to treatment failure.

Results The incidence of medically refractory MS-TN was 1.2/million/year. Twenty-one patients with 26 surgically treated sides underwent first rhizotomy including 13 GammaKnife and 13 percutaneous rhizotomies comprised of ten glycerol injections and three balloon compressions. Subsequent procedures were required on 23 sides (88%), including 24 GammaKnife, 19 glycerol injections, 25 balloon compressions, two microvascular decompressions, and four open partial surgical rhizotomies with a total of 99 surgeries on 26 sides (range, 1–12 each).

Conclusions The majority of MS-TN patients become medically refractory and require multiple repeat surgical procedures. MS-TN procedures were associated with high rates of pain recurrence and our data suggests reoperation within 1 year is often necessary. Optimal management strategy in this patient population remains to be determined. Patients need to be counseled on managing expectations as treatments commonly afford only temporary relief.

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