Novel surgery eases refractory MS-related facial pain for 43 months

A case report in Chinese Neurosurgical Journal describes a salvage operation that kept a woman with treatment-resistant multiple sclerosis-related trigeminal neuralgia pain-free on the treated side for 43 months. The combined approach may offer a new option for rare patients who have exhausted medication, injections and radiosurgery.

Why it matters: - Multiple sclerosis-related trigeminal neuralgia can cause extreme facial pain and is often harder to treat than classical trigeminal neuralgia. - Patients who do not respond to medication, percutaneous procedures or radiosurgery have few remaining options. - The report suggests a possible salvage strategy for a small group of patients with no neurovascular compression, where standard microvascular decompression is not appropriate.

What happened: - A case report in the Chinese Neurosurgical Journal described a combined surgical approach for refractory multiple sclerosis-related trigeminal neuralgia. - Dr. Thomas Patrick Short and Dr. Chandrasekaran Kaliaperumal of the Royal Infirmary of Edinburgh reported the case in Volume 12, Issue 14, published May 14, 2026. - The paper described a retrosigmoid posterior fossa exploration followed by internal neurolysis and targeted proximal trigeminal root glycerol delivery. - The patient was a 50-year-old woman with relapsing-remitting multiple sclerosis and severe right-sided facial pain.

The details: - The patient’s pain affected the maxillary and mandibular divisions of the trigeminal nerve and interfered with speaking, eating and facial contact. - She had already tried anticonvulsant medications, two percutaneous glycerol rhizotomies and Gamma Knife radiosurgery. - MRI showed multiple demyelinating lesions consistent with multiple sclerosis, including abnormalities extending toward the trigeminal root entry zone. - No neurovascular compression was seen, which ruled out conventional microvascular decompression as a suitable option. - During surgery, no neurovascular conflict was found. - Internal neurolysis, also called nerve combing, was used to separate trigeminal nerve fascicles without cutting the nerve. - Surgeons then delivered a small volume of anhydrous glycerol to the proximal cisternal segment of the trigeminal root near the radiologically relevant lesion. - The patient had immediate postoperative pain improvement. - Trigeminal sensation was preserved, and there were no new neurological deficits, corneal problems or clinically significant facial numbness. - A wound infection later required surgical washout and antibiotics, but the team reported no trigeminal nerve-related complications. - The original report was titled “Combined internal neurolysis and targeted proximal trigeminal root glycerol delivery for refractory multiple sclerosis–related trigeminal neuralgia: a case report.” - The paper’s DOI is 10.1186/s41016-026-00433-x.

Between the lines: - The authors said the technique was designed to address pain at a more proximal anatomical site than earlier percutaneous procedures. - They said the case may support root-level surgical strategies in carefully selected patients with refractory MS-TN. - Dr. Short said the report is, to their knowledge, the first published description of this combined technique for trigeminal neuralgia caused by multiple sclerosis. - The findings are based on a single case, so they are hypothesis-generating rather than practice-defining.

What’s next: - At five months, the patient reported substantial improvement with only occasional residual pain. - At one year, the patient remained free of recurrent trigeminal neuralgia on the treated side and had reduced medication needs. - Her Barrow Neurological Institute pain intensity score improved from V before surgery to I after surgery. - Follow-up at 19, 26 and 43 months showed sustained pain freedom on the operated side. - Later intermittent facial pain on the opposite side was controlled with low-dose medication and was not a recurrence of the original symptoms. - The authors say further research is needed to test whether combined internal neurolysis and targeted proximal trigeminal root glycerol delivery could become a future salvage option for selected patients.

The bottom line: - A one-patient report cannot change practice, but 43 months of pain relief suggests a new surgical path worth studying for the hardest cases of MS-related trigeminal neuralgia. - More information: Chinese Neurosurgical Journal