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MS-Related TN – MVD Limitations — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationMS-Related TN – MVD LimitationsSCE Neurology

A 65-year-old man with MS develops trigeminal neuralgia. MRI shows a demyelinating plaque at the trigeminal root entry zone and also demonstrates neurovascular compression of the trigeminal nerve by the SCA. Is microvascular decompression likely to be effective?

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Correct answer: E — MVD is generally less effective in MS-related TN than in classical TN because the primary pathology is demyelination rather than vascular compression

While neurovascular compression may coexist with demyelinating lesions in MS patients with TN, the primary mechanism of pain is demyelination at the root entry zone rather than vascular compression. Consequently, MVD is generally less effective in MS-related TN than in classical TN (which is primarily vascular in aetiology). Ablative procedures (percutaneous balloon compression, glycerol rhizolysis, radiofrequency thermocoagulation) may be more appropriate surgical options for MS-related TN refractory to medication. A: MVD has lower success rates in MS-TN. C: It is not absolutely contraindicated but is less effective. D: Age is not the determining factor. E: Medication should always be tried first.

Reference: EAN TN Guidelines (2019); ABN Trigeminal Neuralgia Guidelines