scholarly journals Gamma Knife radiosurgery for cluster-tic syndrome unresponsive to medical treatment: illustrative case

2021 ◽  
Vol 2 (4) ◽  
Author(s):  
Lina R. Barzaghi ◽  
Edoardo Pompeo ◽  
Luigi Albano ◽  
Antonella Del Vecchio ◽  
Pietro Mortini
Keyword(s):  
Trigeminal Neuralgia ◽  
Cluster Headache ◽  
Medical Treatment ◽  
Gamma Knife ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Gamma Knife Radiosurgery ◽  
Pharmacological Therapy ◽  
Illustrative Case ◽  
Pain Intensity Score

BACKGROUND Cluster-tic syndrome is a disorder characterized by the coexistence of symptoms related to both cluster headache and trigeminal neuralgia. Etiopathogenesis is not yet well defined. Medical treatment, including drugs for both cluster headache and trigeminal neuralgia, is the first therapeutic choice, whereas more invasive treatments are indicated in the case of pharmacological therapy failure or in the presence of drug side effects. To date, no randomized and/or large cohort trials describing Gamma Knife radiosurgery (GKRS) for cluster-tic syndrome are available, probably due to the syndrome’s rarity. OBSERVATIONS The authors describe the case of a 76-year-old woman with refractory cluster-tic syndrome who underwent GKRS with double target (the retrogasserian portion of the trigeminal nerve and the sphenopalatine ganglion). The Numerical Rating Scale (NRS) of pain and the Barrow Neurological Institute (BNI) pain intensity score before treatment were 7 (up to 10 during paroxysmal pain attacks) and V, respectively. At last follow-up, 24 months after GKRS, the patient had discontinued her pain medications and NRS and BNI pain scores were 1 and I, respectively. No trigeminal sensory disorders were reported. LESSONS The present case shows that GKRS, in selected cases, could be an effective treatment in patients with refractory cluster-tic syndrome.

Gamma Knife radiosurgery for trigeminal neuralgia: the impact of magnetic resonance imaging–detected vascular impingement of the affected nerve

2010 ◽  
Vol 113 (1) ◽  
pp. 53-58 ◽  
Author(s):  
Jason P. Sheehan ◽  
Dibyendu Kumar Ray ◽  
Stephen Monteith ◽  
Chun Po Yen ◽  
James Lesnick ◽  
...  
Keyword(s):  
Pain Relief ◽  
Mr Imaging ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Trigeminal Nerve ◽  
Gamma Knife Radiosurgery ◽  
Vascular Compression ◽  
Pain Intensity Score ◽  
The Impact

Object Trigeminal neuralgia is believed to be related to vascular compression of the affected nerve. Radiosurgery has been shown to be reasonably effective for treatment of medically refractory trigeminal neuralgia. This study explores the rate of occurrence of MR imaging–demonstrated vascular impingement of the affected nerve and the extent to which vascular impingement affects pain relief in a population of trigeminal neuralgia patients undergoing Gamma Knife radiosurgery (GKRS). Methods The authors performed a retrospective analysis of 106 cases involving patients treated for typical trigeminal neuralgia using GKRS. Patients with or without single-vessel impingement on CISS MR imaging sequences and with no previous surgery were included in the study. Pain relief was assessed according to the Barrow Neurological Institute (BNI) pain intensity score at the last follow-up. Degree of impingement, nerve diameter preand post-impingement, isocenter placement, and dose to the point of maximum impingement were evaluated in relation to the improvement of BNI score. Results The overall median follow-up period was 31 months. Overall, a BNI pain score of 1 was achieved in 59.4% of patients at last follow-up. Vessel impingement was seen in 63 patients (59%). There was no significant difference in pain relief between those with and without vascular impingement following GKRS (p > 0.05). In those with vascular impingement on MR imaging, the median fraction of vessel impingement was 0.3 (range 0.04–0.59). The median dose to the site of maximum impingement was 42 Gy (range 2.9–79 Gy). Increased dose (p = 0.019) and closer proximity of the isocenter to the site of maximum vessel impingement (p = 0.012) correlated in a statistically significant fashion with improved BNI scores in those demonstrating vascular impingement on the GKRS planning MR imaging Conclusions Vascular impingement of the affected nerve was seen in the majority of patients with trigeminal neuralgia. Overall pain relief following GKRS was comparable in those with and without evidence of vascular compression on MR imaging. In subgroup analysis of those with MR imaging evidence of vessel impingement of the affected trigeminal nerve, pain relief correlated with a higher dose to the point of contact between the impinging vessel and the trigeminal nerve. Such a finding may point to vascular changes affording at least some degree of relief following GKRS for trigeminal neuralgia.

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.

Temporal disconnection between pain relief and trigeminal nerve microstructural changes after Gamma Knife radiosurgery for trigeminal neuralgia

2020 ◽  
Vol 133 (3) ◽  
pp. 727-735
Author(s):  
Peter Shih-Ping Hung ◽  
Sarasa Tohyama ◽  
Jia Y. Zhang ◽  
Mojgan Hodaie
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Pain Intensity ◽  
Gamma Knife ◽  
Trigeminal Nerve ◽  
Diffusion Tensor ◽  
Gamma Knife Radiosurgery ◽  
Time Points ◽  
Microstructural Effect

OBJECTIVEGamma Knife radiosurgery (GKRS) is a noninvasive surgical treatment option for patients with medically refractive classic trigeminal neuralgia (TN). The long-term microstructural consequences of radiosurgery and their association with pain relief remain unclear. To better understand this topic, the authors used diffusion tensor imaging (DTI) to characterize the effects of GKRS on trigeminal nerve microstructure over multiple posttreatment time points.METHODSNinety-two sets of 3-T anatomical and diffusion-weighted MR images from 55 patients with TN treated by GKRS were divided within 6-, 12-, and 24-month posttreatment time points into responder and nonresponder subgroups (≥ 75% and < 75% reduction in posttreatment pain intensity, respectively). Within each subgroup, posttreatment pain intensity was then assessed against pretreatment levels and followed by DTI metric analyses, contrasting treated and contralateral control nerves to identify specific biomarkers of successful pain relief.RESULTSGKRS resulted in successful pain relief that was accompanied by asynchronous reductions in fractional anisotropy (FA), which maximized 24 months after treatment. While GKRS responders demonstrated significantly reduced FA within the radiosurgery target 12 and 24 months posttreatment (p < 0.05 and p < 0.01, respectively), nonresponders had statistically indistinguishable DTI metrics between nerve types at each time point.CONCLUSIONSUltimately, this study serves as the first step toward an improved understanding of the long-term microstructural effect of radiosurgery on TN. Given that FA reductions remained specific to responders and were absent in nonresponders up to 24 months posttreatment, FA changes have the potential of serving as temporally consistent biomarkers of optimal pain relief following radiosurgical treatment for classic TN.

Unusual causes of trigeminal neuralgia treated by gamma knife radiosurgery

2002 ◽  
Vol 97 ◽  
pp. 533-535 ◽  
Author(s):  
Jin Woo Chang ◽  
Jae Young Choi ◽  
Young Sul Yoon ◽  
Yong Gou Park ◽  
Sang Sup Chung
Keyword(s):  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Fourth Ventricle ◽  
Gamma Knife Radiosurgery ◽  
Brain Magnetic Resonance Imaging ◽  
Resonance Imaging ◽  
Segmental Demyelination ◽  
Content Type ◽  
Clinical Responses ◽  
Fine Print

✓ The purpose of this paper was to present two cases of secondary trigeminal neuralgia (TN) with an unusual origin and lesion location. In two cases TN was caused by lesions along the course of the trigeminal nerve within the pons and adjacent to the fourth ventricle. Both cases presented with typical TN. Brain magnetic resonance imaging revealed linear or wedge-shaped lesions adjacent to the fourth ventricle, extending anterolaterally and lying along the pathway of the intraaxial trigeminal fibers. The involvement of the nucleus of the spinal trigeminal tract and of the principal sensory trigeminal nucleus with segmental demyelination are suggested as possible causes for trigeminal pain in these cases. It is postulated that these lesions are the result of an old viral neuritis. The patients underwent gamma knife radiosurgery and their clinical responses have been encouraging to date.

scholarly journals Erratum to ‘Gamma Knife Radiosurgery for Trigeminal Neuralgia: Role of Trigeminal Length and Pontotrigeminal Angle on Target Definition and on Clinical Effects’ [World Neurosurgery. 142 (2020), e140-e150]

2021 ◽  
Author(s):  
Lina Raffaella Barzaghi ◽  
Luigi Albano ◽  
Claudia Scudieri ◽  
Carmen Rosaria Gigliotti ◽  
Francesco Nadin ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Clinical Effects ◽  
Target Definition

Gamma knife radiosurgery for the treatment of trigeminal neuralgia: early results of the yale experience

2001 ◽  
Vol 51 (3) ◽  
pp. 61
Author(s):  
D.H. Kim ◽  
A.C. de Lotbiniere ◽  
K.B. Roberts ◽  
J. Bond ◽  
J.P. Knisely
Keyword(s):  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Early Results

Outcome Predictors After Gamma Knife Radiosurgery for Recurrent Trigeminal Neuralgia

Neurosurgery ◽  
2010 ◽  
Vol 67 (6) ◽  
pp. 1637-1645 ◽  
Author(s):  
Hideyuki Kano ◽  
Douglas Kondziolka ◽  
Huai-Che Yang ◽  
Oscar Zorro ◽  
Javier Lobato-Polo ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Pain Control ◽  
Surgical Procedure ◽  
Gamma Knife Radiosurgery ◽  
Sensory Loss ◽  
Failed Surgery ◽  
Gamma Knife Stereotactic Radiosurgery

Abstract BACKGROUND: Trigeminal neuralgia (TN) that recurs after surgery can be difficult to manage. OBJECTIVE: To define management outcomes in patients who underwent gamma knife stereotactic radiosurgery (GKSR) after failing 1 or more previous surgical procedures. METHODS: We retrospectively reviewed outcomes after GKSR in 193 patients with TN after failed surgery. The median patient age was 70 years (range, 26-93 years). Seventy-five patients had a single operation (microvascular decompression, n = 40; glycerol rhizotomy, n = 24; radiofrequency rhizotomy, n = 11). One hundred eighteen patients underwent multiple operations before GKSR. Patients were evaluated up to 14 years after GKSR. RESULTS: After GKSR, 85% of patients achieved pain relief or improvement (Barrow Neurological Institute grade I-IIIb). Pain recurrence was observed in 73 of 168 patients 6 to 144 months after GKSR (median, 6 years). Factors associated with better long-term pain relief included no relief from the surgical procedure preceding GKSR, pain in a single branch, typical TN, and a single previous failed surgical procedure. Eighteen patients (9.3%) developed new or increased trigeminal sensory dysfunction, and 1 developed deafferentation pain. Patients who developed sensory loss after GKSR had better long-term pain control (Barrow Neurological Institute grade I-IIIb: 86% at 5 years). CONCLUSION: GKSR proved to be safe and moderately effective in the management of TN that recurs after surgery. Development of sensory loss may predict better long-term pain control. The best candidates for GKSR were patients with recurrence after a single failed previous operation and those with typical TN in a single trigeminal nerve distribution.

Long term efficacy and patient satisfaction of microvascular decompression and gamma knife radiosurgery for trigeminal neuralgia

2015 ◽  
Vol 22 (5) ◽  
pp. 818-822 ◽  
Author(s):  
Anil Nanda ◽  
Vijayakumar Javalkar ◽  
Shihao Zhang ◽  
Osama Ahmed
Keyword(s):  
Patient Satisfaction ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Microvascular Decompression ◽  
Gamma Knife Radiosurgery ◽  
Term Efficacy

943 poster GAMMA KNIFE RADIOSURGERY (GKRS) IN THE MANAGEMENT OF TRIGEMINAL NEURALGIA (TN): MEDIAN 10 YEAR FOLLOW-UP OF 545 PATIENTS

2011 ◽  
Vol 99 ◽  
pp. S361
Author(s):  
K. Thompson ◽  
R. Mark ◽  
R. Akins ◽  
M. Nair
Keyword(s):  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery
Sign in / Sign up

Export Citation Format

Share Document