Stereotactic radiosurgery for trigeminal neuralgia secondary to Multiple Sclerosis: A systematic review and Meta-Analysis.

BACKGROUND: The management of trigeminal neuralgia secondary to multiple sclerosis (MS-TN) remains clinically challenging due to its refractory course and aggressive symptom pattern. Among available interventions, stereotactic radiosurgery (SRS) has emerged as a minimally invasive and effective option. This systematic review and meta-analysis aims to assess the efficacy and safety of SRS in patients with MS-related trigeminal neuralgia. METHODS: A comprehensive literature search was conducted on March 26, 2025, to identify studies that reported pain-related outcomes and adverse radiation effects (AREs) in patients with MS-TN treated with SRS. RESULTS: A total of 23 studies comprising 837 patients with MS-TN were analyzed. The mean follow-up period across studies ranged from 6.1 to 88.3 months. Pooled results demonstrated an initial pain-free rate of 32 % (95 % CI: 13-55 %) and an initial adequate pain-relief rate of 74 % (95 % CI: 50-92 %). At the final follow-up, the pain-free rate was 17 % (95 % CI: 5-32 %), while adequate pain relief was maintained in 65 % (95 % CI: 50-78 %) of patients. The pooled incidence of AREs following SRS was 9 % (95 % CI: 2-18 %). CONCLUSIONS: SRS shows promising pain outcomes and a low rate of AREs in patients with MS-TN. Nonetheless, larger comparative investigations are required to evaluate different SRS approaches and to determine how MS subtypes may influence treatment response.