• Andres M Alvarez-Pinzon, Aizik L Wolf, Heather N Swedberg, Kory A Barkley, Juan Cucalon, Luciana Curia, and Jose E Valerio.
• Department of Neurological Surgery, Miami Neuroscience Center at Larkin, South Miami, Florida, USA; Biotechnology-Oncology, Advanced Academic Programs, Johns Hopkins University, Baltimore, Maryland, USA. Electronic address: andresmauricioalvarez07@gmail.com.
• World Neurosurg. 2017 Jan 1; 97: 590-594.

ObjectiveWe compared and evaluated percutaneous retrogasserian balloon compression (PBC) and Gamma Knife radiosurgery (GKRS) for treatment of trigeminal neuralgia (TN) in patients with multiple sclerosis (MS).MethodsIn this single-center, retrospective comparative study, 202 patients with MS and concomitant TN were evaluated. A minimum follow-up of 24 months was required. Patients with a history of microvascular decompression or previous intervention were excluded. Between February 2009 and December 2013, 78 PBC procedures and 124 first-dosage GKRS procedures were performed. PBC procedures were successfully completed in all cases. The 2 groups were compared with regard to initial effect, duration of effect, and complications including type and severity.ResultsImmediate pain relief occurred in 87% of patients treated with PBC and in 23% of patients treated with GKRS. Kaplan-Meier plots for the 2 treatment modalities were similar. The 50% recurrence rate was at 12 months for the PBC group and 18 months for the GKRS group. Complication (excluding numbness) rates were 3% for GKRS and 21% for PBC. The difference was statistically significant (χ2 test, P = 0.03).ConclusionsPBC and GKRS are effective techniques for treatment of TN in patients with MS. Fewer complications and superior long-term relief were associated with GKRS. We consider GKRS as the first option for the treatment of TN in patients with MS, reserving PBC for patients with acute, intractable pain.Copyright © 2016 Elsevier Inc. All rights reserved.

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