New research looks at surgical treatment for trigeminal neuralgia associated with multiple sclerosis — and why choosing the right procedure matters.

For people living with both multiple sclerosis (MS) and trigeminal neuralgia (TN), decisions about surgery can be particularly difficult. A systematic review published in Neurosurgical Review on 7 October 2026 brings together recent evidence on surgical treatment for TN associated with MS.

The review included 32 studies, 1,617 patients and 1,805 procedures. It does not identify one operation that is best for everyone. Instead, it reinforces the importance of individual assessment, imaging and careful discussion of benefits, risks and the possibility of pain returning.

Why MS-related TN is different

Multiple sclerosis is a recognised cause of secondary trigeminal neuralgia. Demyelination can affect trigeminal pathways in the brainstem. Some people with MS may also have neurovascular conflict, where a blood vessel is in contact with or compressing the trigeminal nerve.

That combination can make treatment decisions more complicated. A scan may show vascular contact, but it does not always establish which process is driving an individual person’s pain. Clinical assessment remains essential.

What did the review examine?

The researchers reviewed several procedures used for MS-associated TN, including microvascular decompression (MVD), Gamma Knife radiosurgery, percutaneous procedures and partial sensory rhizotomy. They assessed initial pain relief, durability, recurrence and complications.

Across the studies, the procedures generally produced meaningful initial pain relief, but the durability of benefit and complication profile varied considerably. The underlying evidence was also heterogeneous, so the authors did not perform a meta-analysis.

Microvascular decompression

MVD aims to relieve pressure on the trigeminal nerve where neurovascular conflict is present. In the review, MVD could provide durable benefit for selected people with MS-associated TN when neurovascular conflict was demonstrated.

However, the review also found that MVD carried a higher risk of serious complications than less invasive approaches. The authors therefore emphasise cautious patient selection. MVD should not be assumed to be appropriate simply because a person has both MS and TN or because vascular contact is visible on imaging.

Gamma Knife and percutaneous procedures

Gamma Knife radiosurgery and percutaneous ablative procedures produced useful initial pain relief in many of the included studies and generally had more favourable short-term complication profiles than open surgery.

Recurrence was common, however, and repeat procedures were sometimes needed. That matters when discussing treatment because initial pain relief and long-term durability are not the same outcome.

Partial sensory rhizotomy

Partial sensory rhizotomy showed encouraging pain relief and durability in some people with difficult-to-treat MS-associated TN, particularly where neurovascular conflict was absent.

The review authors suggest that this procedure may deserve earlier consideration in selected refractory cases. That is a research conclusion, not a new clinical guideline. Serious sensory complications, including anaesthesia dolorosa, were reported in some of the underlying studies.

There is no single best operation

The most important message from the review is not that one procedure has won. Treatment selection needs to take account of factors such as MRI findings, whether neurovascular conflict is present, previous treatments, the person’s wider neurological health, the likely durability of pain relief and the risks of sensory or other complications.

The review also highlights important limitations in the evidence. Most included studies were retrospective, patient groups and follow-up periods varied, and outcome reporting was inconsistent. The authors call for prospective studies and more standardised reporting.

What does this mean for patients?

If you have MS and facial pain, do not assume that every facial pain symptom is trigeminal neuralgia. Dental disease, jaw disorders, headache conditions and other neuropathic pain can also cause facial pain.

If TN is suspected or diagnosed and medicines are not controlling the pain or are causing unacceptable side effects, specialist assessment can help clarify which options are reasonable to discuss.

Questions you may wish to ask your specialist include:

  • What type of trigeminal neuralgia do you think I have?
  • What does my MRI show?
  • Is there evidence of neurovascular conflict?
  • Why is this procedure being recommended for me?
  • What are the main risks and possible sensory changes?
  • How often does pain return after this procedure?
  • What options would remain if the pain came back?

Research findings cannot determine the right procedure for an individual person. Treatment decisions should be made with an appropriate specialist team after discussion of the person’s diagnosis, imaging, medical history and preferences.

What happens next?

This review is useful because it brings together evidence from a difficult and relatively under-studied area. It supports a personalised approach to surgery for MS-associated TN, but it does not establish a universal treatment pathway.

Further prospective research is needed to understand more clearly how MS subtype, demyelinating plaques, neurovascular conflict and previous treatment affect outcomes.

Research source

Kalyana A, Coles D, Khalil S et al. The efficacy of surgical interventions for trigeminal neuralgia in multiple sclerosis: a systematic review. Neurosurgical Review. Published 7 October 2026.

Further information

Medical disclaimer: This information is for general guidance and does not replace individual medical advice. Do not change prescribed treatment without speaking to the clinician responsible for your care.