Effectiveness of gamma knife radiosurgery in the management of trigeminal neuralgia associated with multiple sclerosis: a systematic review and meta-analysis.

Autor: Ali SMS; Department of Medicine, Liaquat National Hospital & Medical College, Stadium Road, Karachi, 74800, Pakistan., Shafique MA; Department of Medicine, Jinnah Sindh Medical University, Iqbal Shaheed Rd, Karachi, 75510, Pakistan., Mustafa MS; Department of Medicine, Jinnah Sindh Medical University, Iqbal Shaheed Rd, Karachi, 75510, Pakistan., Jafri SAA; Department of Medicine, Liaquat National Hospital & Medical College, Stadium Road, Karachi, 74800, Pakistan., Khalil S; Department of Medicine, Liaquat National Hospital & Medical College, Stadium Road, Karachi, 74800, Pakistan., Fatima H; Department of Medicine, Jinnah Sindh Medical University, Iqbal Shaheed Rd, Karachi, 75510, Pakistan., Rangwala HS; Department of Medicine, Jinnah Sindh Medical University, Iqbal Shaheed Rd, Karachi, 75510, Pakistan. srangwala01@gmail.com.
Jazyk: angličtina
Zdroj: Neurosurgical review [Neurosurg Rev] 2023 Dec 13; Vol. 47 (1), pp. 12. Date of Electronic Publication: 2023 Dec 13.
DOI: 10.1007/s10143-023-02246-3
Abstrakt: Background: Trigeminal neuralgia (TN) is a chronic condition characterized by intense facial pain akin to electric shocks, often associated with the trigeminal nerve. It can be either idiopathic or secondary, with multiple sclerosis (Ms) being a significant contributing factor. Non-responsive patients may opt for minimally invasive procedures, such as gamma knife radiosurgery (GKRS), which offers precise, non-invasive treatment and is frequently chosen as a primary approach. This meta-analysis evaluates the long-term efficacy of GKRS in TN management in Ms patients.
Methods: We conducted a focused search across various databases. Inclusion criteria encompassed studies with ≥ 30 patients using GKRS for TN in Ms, reporting pertinent clinical outcomes. Primary outcomes assessed GKRS efficacy through Barrow Neurological Institute Pain scores. Secondary outcomes encompassed bothersome numbness, facial numbness, and recurrence. Data analysis employed OpenMeta, random effect models, and odds ratios with 95% confidence intervals. Heterogeneity was assessed using I 2 statistics.
Results: Fourteen studies with 752 cases of GKRS for TN were included. Regarding the outcomes, 83% of patients experienced a positive initial pain response, while the overall treatment success rate was 51%. Additionally, 19.6% of patients reported facial numbness, 4.1% experienced bothersome numbness, and 40% faced recurrence. The odds ratio for positive initial pain response was 0.83 (95% CI, 0.76-0.89), while for treatment success, it was 0.51 (95% CI, 0.379-0.639). Facial numbness had an odds ratio of 0.196 (95% CI, 0.130-0.262), bothersome numbness had an odds ratio of 0.041 (95% CI, 0.013-0.069), and recurrence had an odds ratio of 0.403 (95% CI, 0.254-0.551).
Conclusions: In conclusion, treating trigeminal neuralgia in multiple sclerosis patients remains challenging. GKRS shows promise, but customized treatment approaches tailored to individual patient characteristics are urgently needed to address the unique challenges of this condition.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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