scholarly journals Long-term safety and efficacy of Gamma Knife surgery in classical trigeminal neuralgia: a 497-patient historical cohort study

2016 ◽  
Vol 124 (4) ◽  
pp. 1079-1087 ◽  
Author(s):  
Jean Régis ◽  
Constantin Tuleasca ◽  
Noémie Resseguier ◽  
Romain Carron ◽  
Anne Donnet ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Gamma Knife Surgery ◽  
Historical Cohort ◽  
Safety And Efficacy ◽  
Median Delay

OBJECT Gamma Knife surgery (GKS) is one of the surgical alternatives for the treatment of drug-resistant trigeminal neuralgia (TN). This study aims to evaluate the safety and efficacy of GKS in a large population of patients with TN with very long-term clinical follow-up. METHODS Between July 1992 and November 2010, 737 patients presenting with TN were treated using GKS. Data were collected prospectively and were further retrospectively evaluated at Timone University Hospital. The frequency and severity of pain, as well as trigeminal nerve function, were evaluated before GKS and regularly thereafter. Radiosurgery using the Gamma Knife (model B, C, 4C, or Perfexion) was performed with the help of both MR and CT targeting. A single 4-mm isocenter was positioned in the cisternal portion of the trigeminal nerve at a median distance of 7.6 mm (range 4–14 mm) anterior to the emergence of the nerve (retrogasserian target). A median maximum dose of 85 Gy (range 70–90 Gy) was prescribed. RESULTS The safety and efficacy are reported for 497 patients with medically refractory classical TN who were never previously treated by GKS and had a follow-up of at least 1 year. The median age in this series was 68.3 years (range 28.1–93.2 years). The median follow-up period was 43.8 months (range 12–174.4 months). Overall, 456 patients (91.75%) were initially pain free in a median time of 10 days (range 1–180 days). Their actuarial probabilities of remaining pain free without medication at 3, 5, 7, and 10 years were 71.8%, 64.9%, 59.7%, and 45.3%, respectively. One hundred fifty-seven patients (34.4%) who were initially pain free experienced at least 1 recurrence, with a median delay of onset of 24 months (range 0.6–150.1 months). However, the actuarial rate of maintaining pain relief without further surgery was 67.8% at 10 years. The hypesthesia actuarial rate at 5 years was 20.4% and at 7 years reached 21.1%, but remained stable until 14 years with a median delay of onset of 12 months (range 1–65 months). Very bothersome facial hypesthesia was reported in only 3 patients (0.6%). CONCLUSIONS Retrogasserian GKS proved to be safe and effective in the long term and in a very large number of patients. Even if the probability of long-lasting effects may be modest compared with microvascular decompression, the rarity of complications prompts discussion of using GKS as the pragmatic surgical first- or second-intention alternative for classical TN. However, a randomized trial, or at least a case-matched control study, would be required to compare with microvascular decompression.

Long-term outcome of high-dose Gamma Knife surgery in treatment of trigeminal neuralgia

2013 ◽  
Vol 119 (5) ◽  
pp. 1166-1175 ◽  
Author(s):  
Byron Young ◽  
Armin Shivazad ◽  
Richard J. Kryscio ◽  
William St. Clair ◽  
Heather M. Bush
Keyword(s):  
Quality Of Life ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Pain Intensity ◽  
Gamma Knife ◽  
Trigeminal Nerve ◽  
Gamma Knife Surgery

Object Despite the widespread use of Gamma Knife surgery (GKS) for trigeminal neuralgia (TN), controversy remains regarding the optimal treatment dose and target site. Among the published studies, only a few have focused on long-term outcomes (beyond 2 years) using 90 Gy, which is in the higher range of treatment doses used (70–90 Gy). Methods The authors followed up on 315 consecutive patients treated with the Leksell Gamma Knife unit using a 4-mm isocenter without blocks. The isocenter was placed on the trigeminal nerve with the 20% isodose line tangential to the pontine surface (18 Gy). At follow-up, 33 patients were deceased; 282 were mailed an extensive questionnaire regarding their outcomes, but 32 could not be reached. The authors report their analysis of the remaining 250 cases. The patients' mean age at the time of survey response and the mean duration of follow-up were 70.8 ± 13.1 years and 68.9 ± 41.8 months, respectively. Results One hundred eighty-five patients (85.6%) had decreased pain intensity after GKS. Modified Marseille Scale (MMS) pain classifications after GKS at follow-up were: Class I (pain free without medication[s]) in 104 (43.7%), Class II (pain free with medication[s]) in 66 (27.7%), Class III (> 90% decrease in pain intensity) in 23 (9.7%), Class IV (50%–90% decrease in pain intensity) in 20 (8.4%), Class V (< 50% decrease in pain intensity) in 11 (4.6%), and Class VI (pain becoming worse) in 14 (5.9%). Therefore, 170 patients (71.4%) were pain free (Classes I and II) and 213 (89.5%) had at least 50% pain relief. All patients had pain that was refractory to medical management prior to GKS, but only 111 (44.4%) were being treated with medication at follow-up (p < 0.0001). Eighty patients (32.9%) developed numbness after GKS, and 74.5% of patients with numbness had complete pain relief. Quality of life and patient satisfaction on a 10-point scale were reported at mean values (± SD) of 7.8 ± 3.1 and 7.7 ± 3.4, respectively. Most of the patients (87.7%) would recommend GKS to another patient. Patients with prior surgical treatments had increased latency to pain relief and were more likely to continue medicines (p < 0.05). Moreover, presence of altered facial sensations prior to radiosurgery was associated with higher pain intensity, longer pain episodes, more frequent pain attacks, worse MMS pain classification, and more medication use after GKS (p < 0.05). Conversely, increase in numbness intensity after GKS was associated with a decrease in pain intensity and pain length (p < 0.05). Conclusions Gamma Knife surgery using a maximum dose of 90 Gy to the trigeminal nerve provides satisfactory long-term pain control, reduces the use of medication, and improves quality of life. Physicians must be aware that higher doses may be associated with an increase in bothersome sensory complications. The benefits and risks of higher dose selection must be carefully discussed with patients, since facial numbness, even if bothersome, may be an acceptable trade-off for patients with severe pain.

Microvascular decompression for primary trigeminal neuralgia: long-term effectiveness and prognostic factors in a series of 362 consecutive patients with clear-cut neurovascular conflicts who underwent pure decompression

2007 ◽  
Vol 107 (6) ◽  
pp. 1144-1153 ◽  
Author(s):  
Marc Sindou ◽  
José Leston ◽  
Evelyne Decullier ◽  
François Chapuis
Keyword(s):  
Trigeminal Neuralgia ◽  
Success Rate ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Clear Cut ◽  
Kaplan Meier ◽  
History Of ◽  
Primary Trigeminal Neuralgia

Object The purpose of this study was to evaluate the long-term efficacy of microvascular decompression (MVD) and to identify the factors affecting outcome in patients treated for primary trigeminal neuralgia (TN). Only the cases with a clear-cut neurovascular conflict (vascular contact and/or compression of the root entry zone of the trigeminal nerve) found at surgery and treated with “pure” MVD (decompression of the root without any additional lesioning or cutting of the adjacent rootlets) were retained. Methods The study included 362 patients who were followed up over a period of 1 to 18 years (median follow-up 7.2 years). A Kaplan–Meier survival analysis was generated at 1 and 15 years of follow-up for all of the considered factors. According to Kaplan–Meier analysis, the success rate (defined as pain-free patients without any medication) was 91% at 1 year and estimated to be 73.38% after 15 years of follow-up. Results None of the following patient-related factors played any significant role in prognosis: sex, patient age at surgery, history of systemic hypertension, duration of neuralgia before surgery, or history of failed trigeminal surgery. Patients with atypical neuralgia (a baseline of permanent pain) had the same outcome as those with a typical (purely spasmodic) presentation. In addition, the side and topography of the trigeminal nerve did not play a role, whereas involvement of all three divisions of the nerve had a negative effect on outcome. Concerning anatomical factors, neither the type of the compressive vessel nor its location along or around the root was found to be significant. However, the severity of compression was important—the more severe the degree of compression, the better the outcome (p = 0.002). The authors also found that presence of focal arachnoiditis had a negative influence on outcome (p = 0.002). Conclusions Pure MVD can offer patients affected by a primary TN a 73.38% probability of long-term (15 years) cure of neuralgia. The presence of a clear-cut and marked vascular compression at surgery (and possibly—although not yet reliably—on preoperative magnetic resonance imaging) is the guarantee of a higher than 90% success rate.

A prospective cohort study of microvascular decompression and Gamma Knife surgery in patients with trigeminal neuralgia

2008 ◽  
Vol 109 (Supplement) ◽  
pp. 160-172 ◽  
Author(s):  
Mark E. Linskey ◽  
Vaneerat Ratanatharathorn ◽  
Jose Peñagaricano
Keyword(s):  
Cohort Study ◽  
Patient Satisfaction ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Prospective Cohort Study ◽  
Microvascular Decompression ◽  
Prospective Cohort ◽  
Gamma Knife Surgery ◽  
Free Status

Object The aim of this study was to analyze 1 surgeon's 4-year experience with microvascular decompression ([MVD], 36 patients) and Gamma Knife surgery ([GKS], 44 patients) in 80 consecutive patients with trigeminal neuralgia (TN). Methods The authors conducted a prospective cohort study from March 1999 to December 2003 with an independent clinical assessment of the results and serial patient satisfaction surveys. All patients completed a 2004 patient satisfaction survey (0.5–5 years postoperative), and 70% of surviving patients completed the same survey in 2007 (3.9–8.5 years postoperative). Follow-up was undertaken in 100% of the patients (mean 3.4 ± 2.14 years, range 0.17–8.5 years). Results Respective initial and latest follow-up raw pain-free rates were 100 and 80.6% for MVD and 77.3 and 45.5% for GKS. The median time to the maximal benefit after GKS was 4 weeks (range 1 week–6 months). Respective initial, 2-, and 5-year actuarial pain-free rates were 100, 88, and 80% for MVD and 78, 50, and 33% for GKS (p = 0.0002). The relative risk of losing a pain-free status by 5 years posttreatment was 3.35 for patients in the GKS group compared with the MVD group. Initial and 5-year actuarial rates for ≥ 50% pain relief after GKS were 100 and 80%, respectively. The respective rates of permanent mild and severe sensory loss were 5.6 and 0% for patients in the MVD group, as opposed to 6.8 and 2.3% for patients in the GKS group. Anesthesia dolorosa did not occur during the study. Both procedures enjoyed a high degree of early patient satisfaction (95–100%). Microvascular decompression maintained the same rate of patient satisfaction, but satisfaction with GKS decreased to 75% as pain control waned. Twenty-three patients (29%) died of causes unrelated to the TN or the surgical intervention during the follow-up, and their pain status was known at the time of death. Statistically significant intergroup differences for the MVD versus GKS cohorts were age (median 54 years, range 36–70 years vs median 74 years, range 48–92 years, respectively), preoperative symptom duration (median 2.58 years, range 0.33–15 years vs median 7.5, range 0.6–40 years, respectively), and the presence of major comorbidities (2.8 vs 58.3%, respectively). Conclusions In this nonrandomized prospective cohort trial of selected patients with potentially relevant intergroup differences, MVD was significantly superior to GKS in achieving and maintaining a pain-free status in those with TN and provided similar early and superior longer-term patient satisfaction rates compared with those for GKS. The complications of wound cerebrospinal fluid leakage, hearing loss, and persistent diplopia (1 case each in the MVD group) were not seen after GKS.

scholarly journals Glossopharyngeal neuralgia treated by Gamma Knife radiosurgery: safety and efficacy through long-term follow-up

2018 ◽  
Vol 128 (5) ◽  
pp. 1372-1379 ◽  
Author(s):  
Benjamin Pommier ◽  
Gustavo Touzet ◽  
Christian Lucas ◽  
Maximilien Vermandel ◽  
Serge Blond ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Therapeutic Option ◽  
Gamma Knife Radiosurgery ◽  
Jugular Foramen ◽  
Glossopharyngeal Neuralgia ◽  
Symptom Improvement ◽  
Safety And Efficacy

OBJECTIVEGlossopharyngeal neuralgia (GPN) is a rare and disabling condition. Just as for trigeminal neuralgia, Gamma Knife radiosurgery (GKRS) is increasingly proposed as a therapeutic option for GPN. The purpose of this study was to assess long-term safety and efficacy of GKRS for this indication.METHODSFrom 2007 to 2015, 9 patients (4 male and 5 female) underwent a total of 10 GKRS procedures. All of the patients presented with GPN that was refractory to all medical treatment, and all had a long history of pain. One patient had previously undergone surgical microvascular decompression. In 5 cases, a neurovascular conflict had been identified on MRI. For the GKRS procedure, the glossopharyngeal nerve was localized on MRI and CT under stereotactic conditions. The target was located at the glossopharyngeal meatus of the jugular foramen. The dose administered to the nerve was 80 Gy in 3 procedures and 90 Gy in the others. Follow-up was planned for 3, 6, and 12 months after the procedure and annually thereafter.RESULTSEight patients experienced an improvement in their pain. The median length of time from GKRS to symptom improvement in this group was 7 weeks (range 2–12 months). At the first follow-up, 6 patients were pain-free (pain intensity scores of I–III, based on an adaptation of the Barrow Neurological Institute scoring system for trigeminal neuralgia), including 4 patients who were also medication-free (I). One patient had partial improvement (IV) and 2 patients had no change. The mean duration of follow-up was 46 months (range 10–90 months). At the last follow-up 6 patients remained pain-free (pain scores of I–III), including 4 patients who were pain free with no medication (I). No side effect was observed.CONCLUSIONSBecause of its safety and efficacy, GKRS appears to be a useful tool for treatment of GPN, including first-line treatment.

Outcomes of Gamma Knife surgery for trigeminal neuralgia secondary to vertebrobasilar ectasia

2012 ◽  
Vol 116 (1) ◽  
pp. 73-81 ◽  
Author(s):  
Kyung-Jae Park ◽  
Douglas Kondziolka ◽  
Hideyuki Kano ◽  
Oren Berkowitz ◽  
Safee Faraz Ahmed ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Trigeminal Nerve ◽  
Pain Control ◽  
Invasive Procedure ◽  
Gamma Knife Surgery ◽  
Vascular Compression ◽  
Recurrent Pain

Object Vertebrobasilar ectasia (VBE) is an unusual cause of trigeminal neuralgia (TN). The surgical options for patients with medically refractory pain include percutaneous or microsurgical rhizotomy and microvascular decompression (MVD). All such procedures can be technically challenging. This report evaluates the response to a minimally invasive procedure, Gamma Knife surgery (GKS), in patients with TN associated with severe vascular compression caused by VBE. Methods Twenty patients underwent GKS for medically refractory TN associated with VBE. The median patient age was 74 years (range 48–95 years). Prior surgical procedures had failed in 11 patients (55%). In 9 patients (45%), GKS was the first procedure they had undergone. The median target dose for GKS was 80 Gy (range 75–85 Gy). The median follow-up was 29 months (range 8–123 months) after GKS. The treatment outcomes were compared with 80 case-matched controls who underwent GKS for TN not associated with VBE. Results Intraoperative MR imaging or CT scanning revealed VBE that deformed the brainstem in 50% of patients. The trigeminal nerve was displaced in cephalad or lateral planes in 60%. In 4 patients (20%), the authors could identify only the distal cisternal component of the trigeminal nerve as it entered into the Meckel cave. After GKS, 15 patients (75%) achieved initial pain relief that was adequate or better, with or without medication (Barrow Neurological Institute [BNI] pain scale, Grades I–IIIb). The median time until pain relief was 5 weeks (range 1 day–6 months). Twelve patients (60%) with initial pain relief reported recurrent pain between 3 and 43 months after GKS (median 12 months). Pain relief was maintained in 53% at 1 year, 38% at 2 years, and 10% at 5 years. Some degree of facial sensory dysfunction occurred in 10% of patients. Eventually, 14 (70%) of the 20 patients underwent an additional surgical procedure including repeat GKS, percutaneous procedure, or MVD at a median of 14 months (range 5–50 months) after the initial GKS. At the last follow-up, 15 patients (75%) had satisfactory pain control (BNI Grades I–IIIb), but 5 patients (25%) continued to have unsatisfactory pain control (BNI Grade IV or V). Compared with patients without VBE, patients with VBE were much less likely to have initial (p = 0.025) or lasting (p = 0.006) pain relief. Conclusions Pain control rates of GKS in patients with TN associated with VBE were inferior to those of patients without VBE. Multimodality surgical or medical management strategies were required in most patients with VBE.

scholarly journals Decreased Probability of Initial Pain Cessation in Classic Trigeminal Neuralgia Treated With Gamma Knife Surgery in Case of Previous Microvascular Decompression

Neurosurgery ◽  
2015 ◽  
Vol 77 (1) ◽  
pp. 87-95 ◽  
Author(s):  
Constantin Tuleasca ◽  
Romain Carron ◽  
Noémie Resseguier ◽  
Anne Donnet ◽  
Philippe Roussel ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Microvascular Decompression ◽  
Gamma Knife Surgery ◽  
University Hospital ◽  
Lower Probability ◽  
Patient Reported ◽  
History Of ◽  
Global Population

Abstract BACKGROUND: Microvascular decompression (MVD) is the reference technique for pharmacoresistant trigeminal neuralgia (TN). OBJECTIVE: To establish whether the safety and efficacy of Gamma Knife surgery for recurrent TN are influenced by prior MVD. METHODS: Between July 1992 and November 2010, 54 of 737 patients (45 of 497 with &gt;1 year of follow-up) had a history of MVD (approximately half also with previous ablative procedure) and were operated on with Gamma Knife surgery for TN in the Timone University Hospital. A single 4-mm isocenter was positioned in the cisternal portion of the trigeminal nerve at a median distance of 7.6 mm (range, 3.9–11.9 mm) anterior to the emergence of the nerve. A median maximum dose of 85 Gy (range, 70–90 Gy) was delivered. RESULTS: The median follow-up time was 39.5 months (range, 14.1–144.6 months). Thirty-five patients (77.8%) were initially pain free in a median time of 14 days (range, 0–180 days), much lower compared with our global population of classic TN (P = .01). Their actuarial probabilities of remaining pain-free without medication at 3, 5, 7, and 10 years were 66.5%, 59.1%, 59.1%, and 44.3%. The hypoesthesia actuarial rate at 1 year was 9.1% and remained stable until 12 years (median, 8 months). CONCLUSION: Patients with previous MVD showed a significantly lower probability of initial pain cessation compared with our global population with classic TN (P = .01). The toxicity was low (only 9.1% hypoesthesia); furthermore, no patient reported bothersome hypoesthesia. However, the probability of maintaining pain relief without medication was 44.3% at 10 years, similar to our global series of classic TN (P = .85).

Microvascular decompression after failed Gamma Knife surgery for trigeminal neuralgia: a safe and effective rescue therapy?

2010 ◽  
Vol 113 (1) ◽  
pp. 45-52 ◽  
Author(s):  
Raymond F. Sekula ◽  
Andrew M. Frederickson ◽  
Peter J. Jannetta ◽  
Sanjay Bhatia ◽  
Matthew R. Quigley
Keyword(s):  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Rescue Therapy ◽  
Treatment Plan ◽  
Subsequent Treatment ◽  
Gamma Knife Surgery ◽  
Excellent Outcome ◽  
Facial Numbness

Object Stereotactic radiosurgical rhizolysis using Gamma Knife surgery (GKS) is an increasingly popular treatment for medically refractory trigeminal neuralgia. Because of the increasing use of GKS for trigeminal neuralgia, clinicians are faced with the problem of choosing a subsequent treatment plan if GKS fails. This study was conducted to identify whether microvascular decompression (MVD) is a safe and effective treatment for patients who experience trigeminal neuralgia symptoms after GKS. Methods From their records, the authors identified 29 consecutive patients who, over a 2-year period, underwent MVD following failed GKS. During MVD, data regarding thickened arachnoid, adhesions between vessels and the trigeminal nerve, and trigeminal nerve atrophy/discoloration were noted. Outcome and complication data were also recorded. Results The MVD procedure was completed in 28 patients (97%). Trigeminal nerve atrophy was noted in 14 patients (48%). A thickened arachnoid was noted in 1 patient (3%). Adhesions between vessels and the trigeminal nerve were noted in 6 patients (21%) and prevented MVD in 1 patient. At last follow-up, 15 patients (54%) reported an excellent outcome after MVD, 1 (4%) reported a good outcome, 2 (7%) reported a fair outcome, and 10 patients (36%) reported a poor outcome. After MVD, new or worsened facial numbness occurred in 6 patients (21%). Additionally, 3 patients (11%) developed new or worsened troubling dysesthesias. Conclusions Thickened arachnoid, adhesions between vessels and the trigeminal nerve, and trigeminal nerve atrophy/discoloration due to GKS did not prevent completion of MVD. An MVD is an appropriate and safe “rescue” therapy following GKS, although the risks of numbness and troubling dysesthesias appear to be higher than with MVD alone.

Outcomes following single-treatment Gamma Knife surgery for trigeminal neuralgia with a minimum 3-year follow-up

2010 ◽  
Vol 112 (4) ◽  
pp. 766-771 ◽  
Author(s):  
Ron I. Riesenburger ◽  
Steven W. Hwang ◽  
Clemens M. Schirmer ◽  
Vasilios Zerris ◽  
Julian K. Wu ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
Good Treatment ◽  
Complete Pain Relief ◽  
Good Treatment Outcome

Object Gamma Knife surgery (GKS) has been shown to be effective in treating trigeminal neuralgia (TN). Existing studies have demonstrated success rates of 69.1–85% with median follow-up intervals of 19–60 months. However, series with uniform long-term follow-up data for all patients have been lacking. In the present study the authors examined outcomes in a series of patients with TN who underwent a single GKS treatment followed by a minimum follow-up of 36 months. They used a clinical scale that simplifies the reporting of outcome data for patients with TN. Methods Fifty-three consecutive patients with typical, intractable TN received a median maximum radiation dose of 80 Gy applied with a single 4-mm isocenter to the affected trigeminal nerve. Follow-up data were obtained by clinical examination and questionnaire. Outcome results were categorized into the following classes (in order of decreasing success): Class 1A, complete pain relief without medications; 1B, complete pain relief with either a decrease or no change in medications; 1C, ≥ 50% pain relief without medications; 1D, ≥ 50% pain relief with either a decrease or no change in medications; and Class 2, < 50% pain relief and/or increase in medications. Patients with Class 1A–1D outcome (equivalent to Barrow Neurological Institute Grades I–IIIb) were considered to have a good treatment outcome, whereas in patients with Class 2 outcome (equivalent to Barrow Neurological Institute Grades IV and V) treatment was considered to have failed. Results A good treatment outcome from initial GKS was achieved in 31 (58.5%) patients for whom the mean follow-up period was 48 months (range 36–66 months). Outcomes at last follow-up were reflected by class status: Class 1A, 32.1% of patients; 1B, 1.9%; 1C, 3.8%; 1D, 20.8%; and Class 2, 41.5%. Statistical analysis showed no difference in outcomes between patients previously treated with microvascular decompression or rhizotomy compared with patients with no previous surgical treatments. Thirty-six percent of patients reported some degree of posttreatment facial numbness. Anesthesia dolorosa did not develop in any patient. Conclusions Despite a time-dependent deterioration in the success rate of GKS for medically intractable TN, the authors' study showed that > 50% of patients can be expected to have a good outcome based on their scoring system, with ~ 33% having an ideal outcome (pain free with no need for medications). Long-term data, as those presented here, are important when counseling patients on their treatment options.

Repeat Gamma Knife surgery for trigeminal neuralgia: long-term results

2010 ◽  
Vol 113 (Special_Supplement) ◽  
pp. 178-183 ◽  
Author(s):  
Brent Y. Kimball ◽  
Jeffrey M. Sorenson ◽  
David Cunningham
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Trigeminal Nerve ◽  
Treatment Plan ◽  
Gamma Knife Surgery ◽  
Long Term Results ◽  
Long Term Outcome ◽  
Facial Numbness

Object The purpose of this study was to assess the long-term outcome achieved after repeat Gamma Knife surgery (GKS) for trigeminal neuralgia (TN) using a uniform treatment plan. Methods Between 1985 and 2010, 53 patients underwent repeat GKS for refractory TN. In the initial GKS, which involved targeting the root entry zone of the trigeminal nerve, a maximal dose of 80 Gy was used with a 4-mm collimator so that the 50% isodose line abutted the pons. In the second GKS, the treatment plan consisted of a 70-Gy dose directed at a target 4–5 mm distal to the first target on the trigeminal nerve. The mean follow-up duration in these patients was 42 months. Outcomes were defined using the Marseille scale: excellent (Class I or II, no pain with or without medications), good (Class III or IV, ≥ 50% relief), and poor (Class V, < 50% relief). Results Trigeminal neuralgia pain was controlled (≥ 50% improvement with or without medications) after repeat GKS in 70% of patients at 1 year, 50% at 3 years, 50% at 5 years, and 50% at 10 years, as defined by a Kaplan-Meier analysis. A correlation was found between facial numbness and pain relief (p = 0.047). No difference was found between patients with Type 1 TN and those with Type 2 TN, and there was no correlation between the best relief obtained and long-term durability of relief from pain. Twenty-two patients (47.8%) described their trigeminal dysfunction in the following manner: numbness (45.6%), dry eye (10.9%), taste change (8.7%), or jaw weakness (2.2%). In only 8.7% of cases did the patient experience facial numbness that was regarded as bothersome. Conclusions Repeat GKS for TN at the doses used provides substantial long-term relief. Treatment failure occurred up to 28 months after the second GKS. Facial numbness correlated with more durable pain relief after repeat GKS in this series.

Sign in / Sign up

Export Citation Format

Share Document