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.

scholarly journals Glossopharyngeal neuralgia and radiosurgery

2014 ◽  
Vol 121 (Suppl_2) ◽  
pp. 222-225 ◽  
Author(s):  
Roberto Martínez-Álvarez ◽  
Nuria Martínez-Moreno ◽  
M. Elena Kusak ◽  
Germán Rey-Portolés
Keyword(s):  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Maximum Dose ◽  
Gamma Knife Radiosurgery ◽  
Treatment Method ◽  
Jugular Foramen ◽  
Initial Therapy ◽  
Neurological Deficits ◽  
Glossopharyngeal Neuralgia

ObjectGlossopharyngeal neuralgia is difficult to treat. On the basis of results obtained by using Gamma Knife surgery (GKS) to treat trigeminal neuralgia, the authors have used GKS to treat glossopharyngeal neuralgia in a series of patients since 2007. Their objectives with this study were to demonstrate the usefulness and safety of GKS for treating glossopharyngeal neuralgia and to describe a simple treatment method.MethodsFrom 2007 through 2013, the authors treated glossopharyngeal neuralgia in 5 patients (4 women and 1 man), who ranged in age from 36 to 74 years. One patient had previously undergone treatment for trigeminal neuralgia at the Ruber International Hospital, Department of Functional Neurosurgery and Gamma Knife Radiosurgery. For all patients, before GKS, medical management did not control the pain. Three patients had previously undergone surgery (2 microvascular decompression and 1 rhizotomy) without improvement. For the GKS procedure, the nerve was localized by MRI and CT under stereotactic conditions and the target was located at the level of the glossopharyngeal meatus of the jugular foramen. For 1 patient, a maximum dose of 80 Gy was administrated with a 4-mm collimator, and for the others, the maximum dose was 90 Gy. The nerves located near the glossopharyngeal nerve received between 63 and 10 Gy, and the brainstem received less than 10 Gy. The mean follow-up time was 43 months (range 14–83 months).ResultsAll patients improved within 3–6 months after undergoing GKS. All 5 are without pain; 3 patients take no medication, but the other 2 patients continue to take medication. No neurological deficits after GKS were observed.ConclusionsGKS is useful and safe for treating glossopharyngeal neuralgia, even for patients who have previously undergone surgery. GKS should be considered as the initial therapy for glossopharyngeal neuralgia.

Gamma Knife radiosurgery for glossopharyngeal neuralgia: A study of 21 patients with long-term follow-up

Cephalalgia ◽  
2017 ◽  
Vol 38 (3) ◽  
pp. 543-550 ◽  
Author(s):  
Pierre-Yves Borius ◽  
Constantin Tuleasca ◽  
Xavier Muraciole ◽  
Laura Negretti ◽  
Luis Schiappacasse ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Rare Condition ◽  
Glossopharyngeal Neuralgia ◽  
University Hospitals ◽  
Minimally Invasive Surgical ◽  
Long Term Follow Up ◽  
The Mean

Objective Glossopharyngeal neuralgia (GPN) is a very rare condition, affecting the patient’s quality of life. We report our experience in drug-resistant, idiopathic GPN, treated with Gamma Knife radiosurgery (GKRS), in terms of safety and efficiency, on a very long-term basis. Methods The study was opened, self-controlled, non-comparative and bicentric (Marseille and Lausanne University Hospitals). Patients treated with GKRS between 2003 and 2015 (models C, 4C and Perfexion) were included. A single 4-mm isocentre was positioned in the cisternal portion of the glossopharyngeal nerve, with a targeting based both on magnetic resonance imaging (MRI) and computed tomography (CT). The mean maximal dose delivered was 81.4 ± 6.7 Gy (median = 85 Gy, range = 60–90 Gy at the 100% isodose line). Results Twenty-one patients (11 women, 10 men) benefited from 25 procedures. The mean follow-up period was 5.2 ± 3 years (range = 0.9–12.1 years). Seventeen (81%) were initially pain-free after GKRS. At three months, six months and one year after radiosurgery, the percentage of patients with good outcome (BNI classes I to IIIA) was 87.6%, 100% and 81.8%, respectively. Ten cases (58.8%) from the initial pain-free ones had a recurrence, after a mean period of 13.6 ± 10.4 months (range = 3.1–36.6 months). Only three patients (14.2%) had recurrences (two for each one of them) requiring further surgeries. Three patients underwent a second GKRS procedure; one case needed a third GKRS. The former procedures were performed at 7, 17, 19 and 30 months after the first one, respectively. Furthermore, two patients needed additional interventions. At last follow-up, 17 cases (80.9%) were still pain-free without medication. The actuarial pain relief without new surgery was 83%. A transient complication (paraesthesia of the edge of the tongue) was seen in one case (4.8%). Conclusion GKRS is a valuable, minimally invasive, surgical alternative for idiopathic GPN, with a very high short- and long-term efficacy and without permanent complications. A quality imaging, including T2 CISS/Fiesta MRI and bone CT acquisitions for good visualisation of the nerve and the other bony anatomic landmarks, is essential for targeting accuracy and successful therapy.

Long-Term Outcomes in the Treatment of Classical Trigeminal Neuralgia by Gamma Knife Radiosurgery

Neurosurgery ◽  
2016 ◽  
Vol 79 (6) ◽  
pp. 879-888 ◽  
Author(s):  
Nuria E. Martínez Moreno ◽  
Jorge Gutiérrez-Sárraga ◽  
Germán Rey-Portolés ◽  
Adolfo Jiménez-Huete ◽  
Roberto Martínez Álvarez
Keyword(s):  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Response Rates ◽  
Complete Response ◽  
Long Term Outcomes ◽  
Classical Trigeminal Neuralgia ◽  
Facial Numbness

Abstract BACKGROUND: Gamma knife radiosurgery (GKRS) is one of the alternatives for treatment for classical trigeminal neuralgia (TN). OBJECTIVE: To retrospectively analyze long-term outcomes for TN using GKRS achieved at our institution. METHODS: One hundred seventeen patients with medically refractory TN treated by GKRS at our institution were followed up between 1993 and 2011. Mean maximum dose was 86.5 Gy (range: 80-90 Gy; median: 90 Gy). Clinical response was defined based on the Burchiel classification. We considered classes I and II as a complete response. For toxicity, we use the Barrow Neurological Institute facial numbness scale. Mean duration of follow-up was 66 months (range: 24-171 months). RESULTS: Complete response at last follow-up in our patients was 81%, with an excellent response while off medication in 52%. Pain-free rates without medication (class I) were 85% at 3 years (confidence interval [CI]: 78%-94%), 81% at 5 years (CI: 72%-91%), and 76% at 7 years (CI: 65%-90%). Complete response rates (classes I-II) were 91% at 3 years (CI: 86%-97%), 86% at 5 years (CI: 79%-93%), and 82% at 7 years (CI: 72%-93%). Poor treatment response rates differed significantly between patients who had undergone previous surgery and were refractory to management with medication prior to GKRS. New or worsening facial numbness was reported in 32.5% (30% score II and 2.5% score III). No anesthesia dolorosa was reported. Permanent recurrence pain rate was 12%. CONCLUSION: GKRS achieved favorable outcomes compared with surgery in terms of pain relief and complication rates in our cohort of patients, notwithstanding decreasing pain-free survival rates over time. We consider GKRS to be an initial treatment in the management of medically intractable TN in selected patients.

Gamma Knife radiosurgery and refractory glossopharyngeal neuralgia: a single-center series with long-term follow-up

2021 ◽  
Author(s):  
Monica Lara-Almunia ◽  
Nuria E. Martinez Moreno ◽  
Jorge Gutierrez Sarraga ◽  
Roberto Martinez Alvarez
Keyword(s):  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Glossopharyngeal Neuralgia ◽  
Single Center ◽  
Long Term Follow Up

LONG-TERM PAIN RESPONSE AND QUALITY OF LIFE IN PATIENTS WITH TYPICAL TRIGEMINAL NEURALGIA TREATED WITH GAMMA KNIFE STEREOTACTIC RADIOSURGERY

Neurosurgery ◽  
2008 ◽  
Vol 63 (5) ◽  
pp. 915-924 ◽  
Author(s):  
Andrew S. Little ◽  
Andrew G. Shetter ◽  
Mary E. Shetter ◽  
Curt Bay ◽  
C. Leland Rogers
Keyword(s):  
Quality Of Life ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Pain Intensity Score ◽  
Long Term Outcome ◽  
Long Term Treatment

Abstract OBJECTIVE The long-term outcome of patients treated with gamma knife radiosurgery (GKRS) for typical trigeminal neuralgia has not been fully studied. We evaluated 185 patients who underwent their first GKRS treatment between 1997 and 2003 at the Barrow Neurological Institute. METHODS Follow-up was obtained by surveys and review of medical records. Outcomes were assessed by the Barrow Neurological Institute Pain Intensity Score and Brief Pain Inventory. The most common maximum dose was 80 Gy targeted at the root entry zone. Outcomes are presented for the 136 (74%) patients for whom more than 4 years of clinical follow-up data were obtained. RESULTS Treatment failed in 33% of the cohort within 2 years, but only an additional 1% relapsed after 4 years. Actuarial analysis demonstrated that 32% of patients were pain-free off medication and 63% had at least a good outcome at 7 years. When GKRS was used as the primary treatment, 45% of the patients were pain-free at 7 years. In contrast, 10% of patients in whom previous treatment had failed were pain-free. When needed, salvage therapy with repeat GKRS, microvascular decompression, or percutaneous lesioning was successful in 70%. Posttreatment facial numbness was reported as very bothersome in 5%, most commonly in patients who underwent another invasive treatment. After GKRS, 73% reported that trigeminal neuralgia had no impact on their quality of life. CONCLUSION GKRS is a reasonable long-term treatment option for patients with typical trigeminal neuralgia. It yields durable pain control in a majority of patients, as well as improved quality of life with limited complications and it does not significantly affect the efficacy of other surgical treatments, should they be needed.

Long-term outcomes of Gamma Knife radiosurgery for classic trigeminal neuralgia: implications of treatment and critical review of the literature

2009 ◽  
Vol 111 (2) ◽  
pp. 351-358 ◽  
Author(s):  
Anil A. Dhople ◽  
Jared R. Adams ◽  
William W. Maggio ◽  
Shahid A. Naqvi ◽  
William F. Regine ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Response Duration ◽  
Invasive Treatment ◽  
Median Response ◽  
Late Failure

Object Few long-term studies of Gamma Knife surgery (GKS) for trigeminal neuralgia (TN) exist. The authors report their long-term experience with the use of GKS in a previously reported cohort of patients with TN that has now been followed since 1996. Methods One hundred twelve patients with TN were treated with GKS at the University of Maryland between June 1996 and July 2001. Of these, 67% had no invasive operations for TN prior to GKS, 13% had 1, 4% had 2, and 16% had ≥ 3. The right side was affected in 56% of cases, predominantly involving V2 (26%), V3 (24%), or a combination of both (18%) branches. The median age at diagnosis was 56 years, and median age at GKS was 64 years. The median prescription dose of 75 Gy (range 70–80 Gy) was delivered to the involved trigeminal nerve root entry zone. The authors assessed the degree of pain before and after GKS by using the Barrow Neurological Institute (BNI) pain scale. Results In total, 102 patients took the survey at least once, for a response rate of 91%. Although not found to alter the conclusions of this study, 7 cases of atypical TN were found and these patients were removed, for a total of 95 cases herein analyzed. The median follow-up was 5.6 years (range 13–115 months). Before GKS, 88% of patients categorized their pain as BNI IV or V (inadequate control or severe pain on medication), whereas the remainder described their pain as BNI III (some pain, but controlled on medication). After GKS, 64% reported a BNI score of I (no pain, no medications), 5% had BNI II (no pain, still on medication), 12% had BNI III, and 19% reported a BNI score of IV or V. The median time to response was 2 weeks (range 0–12 weeks) and the median response duration was 32 months (range 0–112 months). Eighty-one percent reported initial pain relief, and actuarial rates of freedom from treatment failure at 1, 3, 5, and 7 years were 60, 41, 34, and 22%, respectively. Response duration was significantly better for those who had no prior invasive treatment versus those in whom a previous surgical intervention had failed (32 vs 21 months, p < 0.02). New bothersome facial numbness was reported in 6% of cases. Conclusions This study represents one of the longest reported median follow-up periods and actuarial results for a cohort of patients with classic TN treated with GKS. Although GKS achieves excellent rates of initial pain relief, these results suggest a steady rate of late failure, particularly among patients who had undergone prior invasive surgical treatment. Despite a higher than expected recurrence rate, GKS remains a viable treatment option, particularly for patients who have had no prior invasive procedures. Patients with recurrences can still be offered salvage therapy with either repeat GKS, microvascular decompression, or rhizotomy.

scholarly journals Long Term Outcomes of Gamma Knife Radiosurgery for Typical Trigeminal Neuralgia-Minimum 5-Year Follow-Up

2012 ◽  
Vol 51 (5) ◽  
pp. 276 ◽  
Author(s):  
Jong Kwon Lee ◽  
Hyuk Jai Choi ◽  
Hak Cheol Ko ◽  
Seok Keun Choi ◽  
Young Jin Lim
Keyword(s):  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Long Term Outcomes

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.

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