Abstract：
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 I2 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.
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 I2 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.
摘要：
背景：三叉神经痛（TN）是一种慢性疾病，其特征是类似于电击的剧烈面部疼痛，通常与三叉神经有关。它可以是特发性或继发性的，多发性硬化症（Ms）是一个重要的促成因素。无反应的患者可以选择微创手术，如伽玛刀放射外科(GKRS)，它提供了精确的，非侵入性治疗，经常被选择作为主要方法。这项荟萃分析评估了GKRS在MS患者TN管理中的长期疗效。
方法：我们在各种数据库中进行了重点搜索。纳入标准包括在Ms中使用GKRS进行TN的≥30名患者的研究，报告相关临床结果。主要结果通过BarrowNeurologicalInstitute疼痛评分评估GKRS疗效。次要结果包括烦人的麻木，面部麻木,和复发。数据分析采用OpenMeta，随机效应模型，和95%置信区间的比值比。使用I2统计学评估异质性。
结果：纳入了14项研究，其中752例GKRS治疗TN。关于结果，83％的患者经历了积极的初始疼痛反应，而总体治疗成功率为51%。此外,19.6%的患者报告面部麻木,4.1%的人经历了烦人的麻木，40%面临复发。初始疼痛反应阳性的比值比为0.83（95％CI，0.76-0.89），而为了治疗成功，为0.51（95%CI，0.379-0.639）。面部麻木的比值比为0.196（95%CI，0.130-0.262），烦人的麻木的比值比为0.041(95%CI，0.013-0.069)，复发的比值比为0.403(95%CI,0.254-0.551).
结论：结论：治疗多发性硬化症患者的三叉神经痛仍然具有挑战性。GKRS显示出希望，但是迫切需要针对患者个体特征的定制治疗方法,以应对这种情况的独特挑战.
方法：我们在各种数据库中进行了重点搜索。纳入标准包括在Ms中使用GKRS进行TN的≥30名患者的研究，报告相关临床结果。主要结果通过BarrowNeurologicalInstitute疼痛评分评估GKRS疗效。次要结果包括烦人的麻木，面部麻木,和复发。数据分析采用OpenMeta，随机效应模型，和95%置信区间的比值比。使用I2统计学评估异质性。
结果：纳入了14项研究，其中752例GKRS治疗TN。关于结果，83％的患者经历了积极的初始疼痛反应，而总体治疗成功率为51%。此外,19.6%的患者报告面部麻木,4.1%的人经历了烦人的麻木，40%面临复发。初始疼痛反应阳性的比值比为0.83（95％CI，0.76-0.89），而为了治疗成功，为0.51（95%CI，0.379-0.639）。面部麻木的比值比为0.196（95%CI，0.130-0.262），烦人的麻木的比值比为0.041(95%CI，0.013-0.069)，复发的比值比为0.403(95%CI,0.254-0.551).
结论：结论：治疗多发性硬化症患者的三叉神经痛仍然具有挑战性。GKRS显示出希望，但是迫切需要针对患者个体特征的定制治疗方法,以应对这种情况的独特挑战.
