Microvascular decompression for trigeminal neuralgia and multiple sclerosis [Neurosurgery Wiki]

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====== Microvascular decompression for trigeminal neuralgia and multiple sclerosis ======

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TN patients showed increased serum and CSF levels of specific proteins and that successful surgery normalizes these protein levels, highlighting its potential as an effective treatment. However, the similarity between MS and controls challenges the idea of shared pathophysiology with TN, suggesting distinct underlying mechanisms in these conditions.

Significance: This study advances our understanding of trigeminal neuralgia (TN) and its association with multiple sclerosis (MS). By analysing 92 protein biomarkers, we identified distinctive molecular profiles in TN patients, shedding light on potential pathophysiological mechanisms. The observation that successful surgery normalizes many protein levels suggests a promising avenue for TN treatment. Furthermore, the contrasting protein patterns between TN and MS challenge prevailing assumptions of similarity between the two conditions and point to distinct pathophysiological mechanisms
((Lafta MS, Sokolov AV, Landtblom AM, Ericson H, Schiöth HB, Abu Hamdeh S. Exploring biomarkers in trigeminal neuralgia patients operated with microvascular decompression: A comparison with multiple sclerosis patients and non-neurological controls. Eur J Pain. 2023 Dec 29. doi: 10.1002/ejp.2231. Epub ahead of print. PMID: 38158702.))
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Montano et al. evaluated the results of [[microvascular decompression for trigeminal neuralgia]] (TN) and [[multiple sclerosis]] (MS) and studied the role of several clinical and surgical factors as possible prognosticators of good outcome. To do this they performed, the first [[literature review]] with a pooled analysis of data. A [[PubMed]] search of [[literature]] was conducted using the following terms: "[[microvascular decompression]]", "[[trigeminal neuralgia]]" and "[[multiple sclerosis]]". They screened 64 articles. Of them, 7 studies were eligible for this review. As outcome indicators they used the acute pain relief (APR) and the recurrence of pain. An APR was obtained in 71.42% and a recurrence of pain was reported in 26.00% of cases, respectively. At univariate analysis, younger age at surgery (p = 0.0419) and performing MVD as the first treatment (p = 0.0384) were associated to a higher probability of APR. The evidence of an MRI brainstem lesion related to the TN (p = 0.0482) was associated to a lower probability to obtain an APR after MVD. None of the evaluated factors affect the probability of recurrence of pain. At multivariate analysis the evidence of a brainstem MRI lesion related to the TN emerged as a negative prognosticator of APR (p = 0.0169). Our literature pooled analysis showed that MVD is effective in treating patients with MS-related TN. The evidence on MRI of a demyelinating plaque related to the TN is associated with a worse response to MVD. These data could suggest that MVD would be indicated mainly in patients without brainstem MRI lesions
((Montano N, Rapisarda A, Ioannoni E, Olivi A. Microvascular decompression in
patients with trigeminal neuralgia and multiple sclerosis: results and analysis
of possible prognostic factors. Acta Neurol Belg. 2019 Dec 2. doi:
10.1007/s13760-019-01258-5. [Epub ahead of print] PubMed PMID: 31792763.
)).