Abstract Details

Title A Novel Approach to Treatment of Trigeminal Neuralgia in Multiple Sclerosis Patients Using Minimally Invasive Trigeminal Ablation (MITA)

Topic Multiple Sclerosis

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 15-097

Objective We describe 3 multiple sclerosis patients who became pain free after a novel minimally invasive office procedure to treat trigeminal neuralgia.

Background The prevalence of trigeminal neuralgia (TN) is 20-fold higher among multiple sclerosis (MS) patients than in the general population. MS patients with TN (MSTN) are reported to have atypical manifestations, longer episodes of pain and have less relief of pain with both pharmacological and surgical treatments. Conventional surgical methods have shown a high failure rate in MS patients.

Design/Methods We evaluated 3 MS patients with refractory unilateral TN, resistant to maximum medical treatment for MITA. None of our patients had neurovascular compression on neuroimaging. Two patients had tried a gamma knife procedure without significant pain relief. All 3 patients were evaluated and then underwent MITA. During the initial office visit, the symptomatic nerve is identified with a diagnostic trigeminal block into the peripheral nerve exit site. If patient experiences complete relief and no adverse symptoms with the nerve block, MITA is scheduled in the same-day-surgery suite. Intraoperatively, an incision is made along the buccal mucosa and the tissue is endoscopically dissected in a plane towards the symptomatic nerve. Once isolated, the epineurium is partially ablated circumferentially with thermocautery and the tissue surrounding the nerve is decompressed.

Results All 3 patients had significant improvement in their TN pain after MITA, allowing tapering of medical treatment and all of them were pain free at an average of six months follow up. Two patient had mild hypoesthesia over the ablated nerve territory, not interfering with daily function.

Conclusions MITA is a novel, safe, and effective technique for symptomatic control of trigeminal neuralgia in MSTN patients. The efficacy, low risk, and relative ease of the procedure makes it ideal for use in MS patients refractory to medical management.

Authors/Disclosures
Yasser Tajali, MD (Harford Healthcare) PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Machteld E. Hillen, MD, FAAN (Rutgers-NJMS)	The institution of Dr. Hillen has received research support from Genentech.

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