{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T10:26:13Z","timestamp":1787135173769,"version":"build-2736575974"},"reference-count":28,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sci.","Brain Sciences"],"abstract":"<jats:p>Background: Trigeminal neuralgia associated with multiple sclerosis (TN-MS) is a secondary facial pain syndrome whose clinical and therapeutic features differ substantially from those of classical TN. Although the literature comparing treatment outcomes between TN-MS and classical TN is relatively abundant, evidence on the impact of treatment on quality of life in TN-MS is scarce. In patients with MS\u2014already vulnerable owing to the course of their disease and the burden of its treatments\u2014therapeutic success cannot be defined by pain scales alone, because even modest analgesic improvement and, in particular, a reduction in medication burden may represent meaningful gains. This review aims to reappraise the therapeutic goals in TN-MS. Methods: We provide a critical narrative review of the evidence, explicitly distinguishing direct evidence from indirect evidence extrapolated from the MS and classical-TN literature, across medical therapy, percutaneous procedures, stereotactic radiosurgery, and microvascular decompression (MVD). Results: First-line pharmacotherapy remains standard but is largely extrapolated from classical TN, and tolerability is frequently limited by sedative and motor adverse effects in already polymedicated patients. Percutaneous procedures and radiosurgery provide clinically meaningful relief in selected patients, but recurrence is common and patient-centered outcomes are poorly documented. Surgical exploration of the cerebellopontine angle\u2014including MVD, neurolysis, and combined techniques\u2014should not be categorically excluded on the basis of an MS diagnosis in carefully selected patients, although outcomes are generally less favorable than in classical TN and the direct evidence is limited and vulnerable to selection bias. Conclusions: Future studies should assess treatment impact on additional outcomes such as medication burden, quality of life, fatigue, cognition, and functional status.<\/jats:p>","DOI":"10.3390\/brainsci16080881","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T09:30:53Z","timestamp":1787131853000},"page":"881","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Trigeminal Neuralgia in Multiple Sclerosis: A Critical Review of the Therapeutic Evidence and the Role of Cerebellopontine Angle Surgical Exploration"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4770-8271","authenticated-orcid":false,"given":"Luis","family":"Ley Urzaiz","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario Ram\u00f3n y Cajal, 28034 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3551-5421","authenticated-orcid":false,"given":"Rodrigo","family":"Carrasco Moro","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario Ram\u00f3n y Cajal, 28034 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.wneu.2017.12.147","article-title":"A systematic review of the management of trigeminal neuralgia in patients with multiple sclerosis","volume":"111","author":"Zakrzewska","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s10194-019-0969-0","article-title":"Trigeminal neuralgia secondary to multiple sclerosis: From the clinical picture to the treatment options","volume":"20","author":"Maarbjerg","year":"2019","journal-title":"J. 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