Evidence map›Paper›PMID 39638949›Full record

ArticleNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology2025

Trigeminal neuralgia in multiple sclerosis: proposal of surgical flowchart and long-term outcome evaluation in a mono-istitutional cohort.

Elio Mazzapicchi, Morgan Broggi, Francesco Restelli, Michela Eloisa Moretti, Marco Paolo Schiariti, Jacopo Falco, Paolo Confalonieri, Laura Brambilla, Sebastiano Giuseppe Crisafulli, Paolo Ferroli and 1 more

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Article in Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Surgical Options for Cranial Nerve Functional Diseases.Advances and technical standards in neurosurgery · 2026
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4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Elio MazzapicchiDepartment of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, University of Milan, Milan, Italy.
Morgan BroggiDepartment of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, University of Milan, Milan, Italy. morgan.broggi@istituto-besta.it.ORCID http://orcid.org/0000-0001-8818-1317
Francesco RestelliDepartment of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, University of Milan, Milan, Italy.
Michela Eloisa MorettiDepartment of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, University of Milan, Milan, Italy.
Marco Paolo SchiaritiDepartment of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, University of Milan, Milan, Italy.
Jacopo FalcoDepartment of Neurosurgery, Great Metropolitan Hospital Niguarda, University of Milan, Milan, Italy.
Paolo ConfalonieriDepartment of Neurology, Fondazione IRCCS Istituto Neurologico C. Besta, University of Milan, Milan, Italy.
Laura BrambillaDepartment of Neurology, Fondazione IRCCS Istituto Neurologico C. Besta, University of Milan, Milan, Italy.
Sebastiano Giuseppe CrisafulliDepartment of Neurology, Fondazione IRCCS Istituto Neurologico C. Besta, University of Milan, Milan, Italy.
Paolo FerroliDepartment of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, University of Milan, Milan, Italy.
Francesco AcerbiUnit of Neurosurgery, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTrigeminal neuralgia (TN) is a chronic pain syndrome more prevalent in patients with multiple sclerosis (MS), often presenting with earlier onset and more intense pain compared to non-MS patients. The management of TN in MS is complex due to the interaction between demyelination and neurovascular factors.

methodsA retrospective analysis of 35 MS patients treated for TN with 65 procedures between 2010 and 2023 was conducted. Patients underwent surgical treatments guided by a flowchart and based on the presence of NVC and patient risk factors. Procedures included MVD, PBC, SRS and TRZ. Outcomes were assessed using BNI pain and hypoesthesia scales, focusing on pain recurrence and changes in antineuralgic medication.

resultsAfter first treatment, MVD (13 procedures) achieved a 100% success rate with a mean pain-free interval of 59.4 months, and 77% of patients reduced or stopped medication. PBC (16) had a 93.8% success rate and a recurrence time of 34 months. SRS showed an 80% success rate with a recurrence time of 7.4 months, while TRZ had a 50% success rate with 24 months of pain-free duration. After the first surgical intervention, 30.5% of patients were pain-free, increasing to 40% after the third treatment. At last follow-up (77,0 ± 68.7 months) it was demonstrated high pain-free rates (61.1%) and good long-term pain control.

conclusionThe use of a tailored flowchart significantly improves outcomes in TN-MS patients. MVD provides the longest pain-free intervals when NVC is present, while PBC, SRS, and TRZ remain viable alternatives for those with contraindications. Personalized approaches enhance pain control and reduce recurrence.

Indexed as

Microvascular Decompression SurgeryMultiple SclerosisTrigeminal NeuralgiaAdultAgedCohort StudiesFemaleHumansMaleMiddle AgedRetrospective StudiesTreatment OutcomeMicrovascular Decompression (MVD)Multiple SclerosisNeurovascular ConflictSurgical FlowchartTrigeminal Neuralgia

Identifiers

PMID39638949

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.