Stereotactic radiosurgery for trigeminal neuralgia: a multiinstitutional study using the gamma unit

1996 ◽  
Vol 84 (6) ◽  
pp. 940-945 ◽  
Author(s):  
Douglas Kondziolka ◽  
L. Dade Lunsford ◽  
John C. Flickinger ◽  
Ronald F. Young ◽  
Sandra Vermeulen ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Stereotactic Radiosurgery ◽  
Good Control ◽  
Dose Selection ◽  
Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Fine Print

✓ A multiinstitutional study was conducted to evaluate the technique, dose-selection parameters, and results of gamma knife stereotactic radiosurgery in the management of trigeminal neuralgia. Fifty patients at five centers underwent radiosurgery performed with a single 4-mm isocenter targeted at the nerve root entry zone. Thirty-two patients had undergone prior surgery, and the mean number of procedures that had been performed was 2.8 (range 1–7). The target dose of the radiosurgery used in the current study varied from 60 to 90 Gy. The median follow-up period after radiosurgery was 18 months (range 11–36 months). Twenty-nine patients (58%) responded with excellent control (pain free), 18 (36%) obtained good control (50%–90% relief), and three (6%) experienced treatment failure. The median time to pain relief was 1 month (range 1 day–6.7 months). Responses remained consistent for up to 3 years postradiosurgery in all cases except three (6%) in which the patients had pain recurrence at 5, 7, and 10 months. At 2 years, 54% of patients were pain free and 88% had 50% to 100% relief. A maximum radiosurgical dose of 70 Gy or greater was associated with a significantly greater chance of complete pain relief (72% vs. 9%, p = 0.0003). Three patients (6%) developed increased facial paresthesia after radiosurgery, which resolved totally in one case and improved in another. No patient developed other deficits or deafferentation pain. The proximal trigeminal nerve and root entry zone, which is well defined on magnetic resonance imaging, is an appropriate anatomical target for radiosurgery. Radiosurgery using the gamma unit is an additional effective surgical approach for the management of medically or surgically refractory trigeminal neuralgia. A longer-term follow-up review is warranted.

Gamma knife radiosurgery using 90 Gy for trigeminal neuralgia

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 152-154 ◽  
Author(s):  
Bradley Nicol ◽  
William F. Regine ◽  
Claire Courtney ◽  
Ali Meigooni ◽  
Michael Sanders ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Complete Relief ◽  
Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Good Pain Control ◽  
Fine Print

Object. The purpose of this paper was to assess the treatment of trigeminal neuralgia (TN) with the higher than normal dose of 90 Gy. Methods. Forty-two patients with typical TN were treated over a 3-year period with gamma knife radiosurgery. Every patient received a maximum dose of 90 Gy in a single 4-mm isocenter targeted to the root entry zone of the trigeminal nerve. Thirty of 42 patients had undergone no prior treatments. The median follow-up period was 14 months (range 2–30 months). Thirty-one patients (73.8%) achieved complete relief of pain. Nine patients (21.4%) obtained good pain control. Complications were limited to increased facial paresthesia in seven patients (16.7%) and dysgeusia in four patients (9.5%). Conclusions. The authors conclude that the use of 90 Gy is a safe and effective dose for the treatment of TN.

Dedicated linear accelerator radiosurgery for the treatment of trigeminal neuralgia

2003 ◽  
Vol 99 (3) ◽  
pp. 511-516 ◽  
Author(s):  
Zachary A. Smith ◽  
Antonio A. F. De Salles ◽  
Leonardo Frighetto ◽  
Bryan Goss ◽  
Steve P. Lee ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Linear Accelerator ◽  
Facial Pain ◽  
Content Type ◽  
Excellent Outcome ◽  
Linac Radiosurgery ◽  
Root Entry Zone ◽  
Fine Print

Object. In this study the authors evaluate the efficacy of and complications associated with dedicated linear accelerator (LINAC) radiosurgery for trigeminal neuralgia (TN). Methods. Between August 1995 and February 2001, 60 patients whose median age was 66.1 years (range 45–88 years) were treated with dedicated LINAC radiosurgery for TN. Forty-one patients (68.3%) had essential TN, 12 (20%) had secondary facial pain, and seven (11.7%) had atypical features. Twenty-nine patients (48.3%) had undergone previous surgical procedures. Radiation doses varied between 70 and 90 Gy (mean 83.3 Gy) at the isocenter, with the last 35 patients (58.3%) treated with a 90-Gy dose. A 5-mm collimator was used in 45 patients (75%) and a 7.5-mm collimator in 15 patients (25%). Treatment was focused at the nerve root entry zone. At last follow up (mean follow-up period 23 months, range 2–70 months), 36 (87.8%) of the 41 patients with essential TN had sustained significant pain relief (good plus excellent results). Twenty-three patients (56.1%) were pain free without medication (excellent outcome), 13 (31.7%) had a 50 to 90% reduction in pain with or without medication (good outcome), and five (12.2%) had minor improvement or no relief. Of 12 patients with secondary facial pain, significant relief was sustained in seven patients (58.3%); worse results were found with atypical pain. Fifteen (25%) of the 60 patients experienced new numbness postprocedure; no other significant complications were found. Pain relief was experienced at a mean of 2.7 months (range 0–12 months). Conclusions. Dedicated LINAC radiosurgery is a precise and effective treatment for TN.

Microvascular decompression for trigeminal neuralgia

1982 ◽  
Vol 57 (4) ◽  
pp. 487-490 ◽  
Author(s):  
Robert Breeze ◽  
Ronald J. Ignelzi
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Late Recurrence ◽  
Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Early Success ◽  
Trigeminal Nerve Root ◽  
Fine Print

✓ Fifty-one consecutive patients with trigeminal neuralgia underwent 52 procedures for microvascular decompression of the trigeminal nerve root entry zone. There was an 85% early success rate; however, after a longer follow-up period, a 13% late recurrence rate was found. In all, 60% of the patients experienced some form of complication, but in only 23% was the complication persistent.

Dorsal root entry zone lesions to control central pain in paraplegics

1981 ◽  
Vol 55 (3) ◽  
pp. 414-419 ◽  
Author(s):  
Blaine S. Nashold ◽  
Elizabeth Bullitt
Keyword(s):  
Dorsal Root ◽  
Central Pain ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Cord Injury ◽  
Fine Print

✓ Thirteen patients with intractable long-term pain following spinal cord injury and paraplegia were treated with dorsal root entry zone lesions placed at the level just above the transection. Pain relief of 50% or more was achieved in 11 of the 13 patients, with follow-up periods ranging from 5 to 38 months. A previous report showed that central pain from brachial plexus avulsion could be relieved by dorsal root entry zone lesions, and this technique has been extended to the central pain phenomena associated with spinal trauma and paraplegia.

Long-term outcome after operation for trigeminal neuralgia in patients with posterior fossa tumors

1996 ◽  
Vol 84 (5) ◽  
pp. 818-825 ◽  
Author(s):  
Fred G. Barker ◽  
Peter J. Jannetta ◽  
Ramesh P. Babu ◽  
Spiros Pomonis ◽  
David J. Bissonette ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Posterior Fossa ◽  
Trigeminal Nerve ◽  
Posterior Fossa Tumors ◽  
Duration Of Symptoms ◽  
Long Term Outcome ◽  
Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Fine Print

✓ During a 20-year period, 26 patients with typical symptoms of trigeminal neuralgia were found to have posterior fossa tumors at operation. These cases included 14 meningiomas, eight acoustic neurinomas, two epidermoid tumors, one angiolipoma, and one ependymoma. The median patient age was 60 years and 69% of the patients were women. Sixty-five percent of the symptoms were left sided. The median preoperative duration of symptoms was 5 years. The distribution of pain among the three divisions of the trigeminal nerve was similar to that found in patients with trigeminal neuralgia who did not have tumors; however, more divisions tended to be involved in the tumor patients. The mean postoperative follow-up period was 9 years. At operation, the root entry zone of the trigeminal nerve was examined for vascular cross-compression in 21 patients. Vessels compressing the nerve at the root entry zone were observed in all patients examined. Postoperative pain relief was frequent and long lasting. Using Kaplan—Meier methods the authors estimated excellent relief in 81% of the patients 10 years postoperatively, with partial relief in an additional 4%.

Microvascular relations of the trigeminal nerve

1980 ◽  
Vol 52 (3) ◽  
pp. 381-386 ◽  
Author(s):  
Stephen J. Haines ◽  
Peter J. Jannetta ◽  
David S. Zorub
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Facial Pain ◽  
Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Venous Compression ◽  
Trigeminal Nerve Root ◽  
Trigeminal Nerves ◽  
Fine Print

✓ The vascular relationships of the trigeminal nerve root entry zone were examined bilaterally in 20 cadavers of individuals known to be free of facial pain. Fourteen of 40 nerves made contact with an artery, but only four of these showed evidence of compression or distortion of the nerve. In addition, the vascular relationships of 40 trigeminal nerves exposed surgically for treatment of trigeminal neuralgia were studied, and 31 nerves showed compression by adjacent arteries. Venous compression was seen in four of the cadaver nerves and in eight nerves from patients with trigeminal neuralgia. These data support the hypothesis that arterial compression of the trigeminal nerve is associated with trigeminal neuralgia.

Predictors of outcome in surgically managed patients with typical and atypical trigeminal neuralgia: comparison of results following microvascular decompression

2002 ◽  
Vol 96 (3) ◽  
pp. 527-531 ◽  
Author(s):  
Elizabeth C. Tyler-Kabara ◽  
Amin B. Kassam ◽  
Michael H. Horowitz ◽  
Louise Urgo ◽  
Constantinos Hadjipanayis ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Long Term Results ◽  
Content Type ◽  
Significant Pain ◽  
Fine Print

Object. Microvascular decompression (MVD) has become one of the primary treatments for typical trigeminal neuralgia (TN). Not all patients with facial pain, however, suffer from the typical form of this disease; many patients who present for surgical intervention actually have atypical TN. The authors compare the results of MVD performed for typical and atypical TN at their institution. Methods. The results of 2675 MVDs in 2264 patients were reviewed using information obtained from the department database. The authors examined immediate postoperative relief in 2003 patients with typical and 672 with atypical TN, and long-term follow-up results in patients for whom more than 5 years of follow-up data were available (969 with typical and 219 with atypical TN). Outcomes were divided into three categories: excellent, pain relief without medication; good, mild or intermittent pain controlled with low-dose medication; and poor, no or poor pain relief with large amounts of medication. The results for typical and atypical TN were compared and patient history and pain characteristics were evaluated for possible predictive factors. Conclusions. In this study, MVD for typical TN resulted in complete postoperative pain relief in 80% of patients, compared with 47% with complete relief in those with atypical TN. Significant pain relief was achieved after 97% of MVDs in patients with typical TN and after 87% of these procedures for atypical TN. When patients were followed for more than 5 years, the long-term pain relief after MVD for those with typical TN was excellent in 73% and good in an additional 7%, for an overall significant pain relief in 80% of patients. In contrast, following MVD for atypical TN, the long-term results were excellent in only 35% of cases and good in an additional 16%, for overall significant pain relief in only 51%. Memorable onset and trigger points were predictive of better postoperative pain relief in both atypical and typical TN. Preoperative sensory loss was a negative predictor for good long-term results following MVD for atypical TN.

Gamma knife surgery for refractory postherpetic trigeminal neuralgia: targeting in one session both the retrogasserian trigeminal nerve and the centromedian nucleus of the thalamus

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 276-282 ◽  
Author(s):  
Marcus F. Keep ◽  
Paul A. DeMare ◽  
Lynn S. Ashby
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Treatment Session ◽  
Single Treatment ◽  
Content Type ◽  
Centromedian Nucleus ◽  
Single Treatment Session ◽  
Fine Print

Object. The authors tested the hypothesis that two targets are needed to treat postherpetic trigeminal neuralgia (TN): one in the trigeminal nerve for the direct sharp pain and one in the thalamus for the diffuse burning pain. Methods. Three patients with refractory postherpetic TN were treated with gamma knife surgery (GKS) through a novel two-target approach. In a single treatment session, both the trigeminal nerve and centromedian nucleus were targeted. First, the trigeminal nerve, ipsilateral to the facial pain, was treated with 60 to 80 Gy. Second, the centromedian nucleus was localized using standard coordinates and by comparing magnetic resonance images with a stereotactic atlas. A single dose of 120 to 140 Gy was delivered to the target point with a single 4-mm isocenter. Patients were followed clinically and with neuroimaging studies. Pain relief was scored as excellent (75–100%), good (50–75%), poor (25–50%), or none (0–25%). Follow up ranged from 6 to 53 months. There were no GKS-related complications. Two patients died of unrelated medical illnesses but had good or excellent pain relief until death. One patient continues to survive with 44 months follow up and no decrease in pain intensity, but with a decreased area of pain. Conclusions. Combined GKS of the centromedian nucleus and trigeminal nerve in a single treatment session is feasible and safe, and the effect was promising. A larger study is required to confirm and expand these results.

Treatment of essential trigeminal neuralgia with gamma knife surgery

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 29-33 ◽  
Author(s):  
Dusan Urgosik ◽  
Roman Liscak ◽  
Josef Novotny ◽  
Josef Vymazal ◽  
Vilibald Vladyka
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Success Rate ◽  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
Recurrent Pain ◽  
Content Type ◽  
Fine Print ◽  
Initial Success Rate

Object. The authors present the long-term follow-up results (minimum 5 years) of patients with essential trigeminal neuralgia (TN) who were treated with gamma knife surgery (GKS). Methods. One hundred seven patients (61 females and 46 males) underwent GKS. The median follow up was time was 60 months (range 12–96 months). The target was the trigeminal root, and the maximum dose was 70 to 80 Gy. Repeated GKS was performed in 19 patients for recurrent pain, and the same dose was used. Initial successful results were achieved in 96% of patients, with complete pain relief in 80.4%. Relief was achieved after a median latency of 3 months (range 1 day–13 months). Gamma knife surgery failed in 4% of patients. Pain recurred in 25% of patients after a median latent interval of 36 months (6–94 months). The initial success rate after a second GKS was 89% and 58% of patients were pain free. Pain relapse occurred in only one patient in this group. Hypesthesia was observed in 20% of patients after the first GKS and in 32% after the second GKS. The median interval to hypaesthesia was 35 months (range 3–94 months) after one treatment and 21 months (range 1–72 months) after a second treatment. Conclusions. The initial success rate of pain relief was high and comparable to that reported in other studies. A higher than usual incidence of sensory impairment after GKS could be the long duration of follow-up study and due to the detailed neurological examination.

Glycerol rhizolysis for treatment of trigeminal neuralgia

1988 ◽  
Vol 69 (1) ◽  
pp. 39-45 ◽  
Author(s):  
Ronald F. Young
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Sensory Loss ◽  
Recurrent Pain ◽  
Pharmacological Agents ◽  
Content Type ◽  
Glycerol Injection ◽  
Glycerol Rhizolysis ◽  
Fine Print

✓ Percutaneous retrogasserian glycerol instillation was performed under local anesthesia for treatment of trigeminal neuralgia in 162 patients. A simplified technique that did not involve cisternography was used. Initial pain relief was achieved in 146 patients (90.1%). Recurrent pain was noted in 27 patients (18.5%) and was more frequent (50%) in patients who had undergone surgical treatments prior to glycerol injection than in those who had no previous surgical treatment (12.3%). A second glycerol injection was carried out in nine patients and a third injection in two patients. The follow-up period extended from 6 to 67 months and 77.8% of patients are totally pain-free after one or more glycerol injections. Another 8.6% experienced good pain relief with the addition of small doses of pharmacological agents. Thus, 140 (86.4%) of the original 162 patients experienced satisfactory pain control following glycerol rhizolysis. Initial sensory loss on the face occurred in 117 patients (71.6%) but at last follow-up examination only 46 patients (28%) experienced mild orofacial hypalgesia and 13 patients (8%) noted analgesia. The corneal reflex was absent in three patients (1.8%) and reduced in five (3.1%). No patients noted corneal ulceration or anesthesia dolorosa. Percutaneous retrogasserian glycerol rhizolysis offers a rapid, safe, reliable, and relatively inexpensive surgical approach to treatment of trigeminal neuralgia.

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