Effect of Cyberknife Radiosurgery for Elderly Patients with Trigeminal Neuralgia

Abstract Objective The incidence of typical trigeminal neuralgia (TN) increases with age, and neurologists and neurosurgeons frequently observe patients with this disorder at age 65 years or older. Microvascular decompression (MVD) of the trigeminal root entry zone in the posterior cranial fossa represents the etiological treatment of typical TN with the highest efficacy and durability of all treatments. This procedure is associated with possible risks (cerebellar hematoma, cranial nerve injury, stroke, and death) not seen with the alternative ablative procedures. Thus the safety of MVD in the elderly remains a topic of discussion. This study was conducted to determine whether MVD is a safe and effective treatment in older patients with TN compared with younger patients. Methods In this retrospective study, 28 patients older than 65 years (elderly cohort: mean age 70.9 ± 3.6 years) and 38 patients < 65 years (younger cohort: mean age 51.7 ± 6.3 years) underwent MVD via the keyhole retrosigmoid approach for type 1 TN (typical) or type 2a TN (typically chronic) from November 2011 to November 2017. A 75-year-old patient and three nonelderly patients with type 2b TN (atypical) were excluded. Elderly and younger cohorts were compared for outcome and complications. Results At a mean follow-up 26.0 ± 5.5 months, 25 patients of the elderly cohort (89.3%) reported a good outcome without the need for any medication for pain versus 34 (89.5%) of the younger cohort. Twenty-three elderly patients with type 1 TN were compared with 30 younger patients with type 1 TN, and no significant difference in outcomes was found (p > 0.05). Five elderly patients with type 2a TN were compared with eight younger patients with type 2a TN, and no significant difference in outcomes was noted (p > 0.05). There was one case of cerebrospinal fluid leak and one of a cerebellar hematoma, both in the younger cohort. Mortality was zero in both cohorts. Conclusions On the basis of our experience and the international literature, age itself does not seem to represent a major contraindication of MVD for TN.

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CYBERKNIFE RADIOSURGERY FOR TRIGEMINAL NEURALGIA TREATMENT

Neurosurgery ◽

10.1227/01.neu.0000317313.46826.dc ◽

2008 ◽

Vol 62 (3) ◽

pp. 647-655 ◽

Cited By ~ 59

Author(s):

Alan T. Villavicencio ◽

Michael Lim ◽

Sigita Burneikiene ◽

Pantaleo Romanelli ◽

John R. Adler ◽

...

Keyword(s):

Pain Relief ◽

Trigeminal Neuralgia ◽

Radiation Doses ◽

Maximal Dose ◽

Median Length ◽

Pain Medications ◽

Idiopathic Trigeminal Neuralgia ◽

Cyberknife Radiosurgery ◽

The Mean

Abstract OBJECTIVE Radiosurgery has gained acceptance as a treatment option for trigeminal neuralgia. We report our preliminary multicenter experience treating trigeminal neuralgia with the CyberKnife (Accuray, Inc., Sunnyvale, CA). METHODS A total of 95 patients were treated for idiopathic trigeminal neuralgia between May 2002 and October 2005. Radiosurgical dose and volume parameters were retrospectively analyzed in relation to pain response, complications, and recurrence of symptoms. Optimal treatment parameters were identified for patients who had excellent and sustained pain relief with no complications, including severe or moderate hypesthesia. RESULTS Excellent pain relief was initially experienced by 64 out of 95 patients (67%). The median time to pain relief was 14 days (range, 0.3–180 d). Posttreatment numbness occurred in 45 (47%) of the patients treated. Using higher radiation doses and treating longer segments of the nerve led to both better pain relief and a higher incidence of hypesthesia. The presence of posttreatment numbness was predictive of better pain relief. The overall rate of complications was 18%. At the mean follow-up time of 2 years, 47 of the 95 patients (50%) had sustained pain relief, all of whom were completely off pain medications. CONCLUSION The results of this study suggest the following optimal radiosurgical treatment parameters for treatment of idiopathic trigeminal neuralgia: a median maximal dose of 78 Gy (range, 70–85.4 Gy) and a median length of the nerve treated of 6 mm (range, 5–12 mm).

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Cyberknife Radiosurgery for Trigeminal Neuralgia

Stereotactic and Functional Neurosurgery ◽

10.1159/000075112 ◽

2003 ◽

Vol 81 (1-4) ◽

pp. 105-109 ◽

Cited By ~ 46

Author(s):

Pantaleo Romanelli ◽

Gary Heit ◽

Steven D. Chang ◽

Dave Martin ◽

Christopher Pham ◽

...

Keyword(s):

Trigeminal Neuralgia ◽

Cyberknife Radiosurgery

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Microvascular decompression for trigeminal neuralgia in elderly patients

Journal of Neurosurgery ◽

10.3171/jns/2008/108/4/0689 ◽

2008 ◽

Vol 108 (4) ◽

pp. 689-691 ◽

Cited By ~ 46

Author(s):

Raymond F. Sekula ◽

Edward M. Marchan ◽

Lynn H. Fletcher ◽

Kenneth F. Casey ◽

Peter J. Jannetta

Keyword(s):

Trigeminal Neuralgia ◽

Elderly Patients ◽

Microvascular Decompression ◽

The Elderly ◽

Outcome Data ◽

Control Group ◽

Younger Patients ◽

Telephone Interviews ◽

Second Tier

Object Although microvascular decompression (MVD) for patients with medically refractory trigeminal neuralgia (TN) is widely accepted as the treatment of choice, other “second-tier” treatments are frequently offered to elderly patients due to concerns regarding fitness for surgery. The authors sought to determine the safety and effectiveness of MVD for TN in patients older than 75 years of age. Methods The authors performed a retrospective review of medical records and conducted follow-up telephone interviews with the patients. The outcome data from 25 MVD operations for TN performed in 25 patients with a mean age of 79.4 years (range 75–88 years) were compared with those of a control group of 25 younger patients with a mean age of 42.3 years (range 17–50 years) who underwent MVDs during the same 30-month period from July 2000 to December 2003. Results Initial pain relief was achieved in 96% of the patients in both groups (p = 1.0). There were no operative deaths in either group. After an average follow-up period of 44 and 52 months, 78 and 72% of patients in the elderly and control groups, respectively, remained pain free without medication (p = 0.74). Conclusions Microvascular decompression is an effective treatment for elderly patients with TN. The authors' experience suggests that the rate of complications and death after MVD for TN in elderly patients is no different from the rate in younger patients.

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The Treatment Outcome of Elderly Patients with Idiopathic Trigeminal Neuralgia : Micro-Vascular Decompression versus Gamma Knife Radiosurgery

Journal of Korean Neurosurgical Society ◽

10.3340/jkns.2008.44.4.199 ◽

2008 ◽

Vol 44 (4) ◽

pp. 199 ◽

Cited By ~ 24

Author(s):

In Ho Oh ◽

Seok Keun Choi ◽

Bong Jin Park ◽

Tae Sung Kim ◽

Bong Arm Rhee ◽

...

Keyword(s):

Treatment Outcome ◽

Trigeminal Neuralgia ◽

Elderly Patients ◽

Gamma Knife ◽

Gamma Knife Radiosurgery ◽

Idiopathic Trigeminal Neuralgia ◽

Vascular Decompression

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Evaluation of CyberKnife Radiosurgery for Recurrent Trigeminal Neuralgia

Cureus ◽

10.7759/cureus.2598 ◽

2018 ◽

Author(s):

Aldo Berti ◽

George Ibars ◽

Xiaodong Wu ◽

Alex Sabo ◽

Michelle Granville ◽

...

Keyword(s):

Trigeminal Neuralgia ◽

Cyberknife Radiosurgery

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Microvascular decompression for elderly patients with trigeminal neuralgia: a prospective study and systematic review with meta-analysis

Journal of Neurosurgery ◽

10.3171/2010.6.jns10142 ◽

2011 ◽

Vol 114 (1) ◽

pp. 172-179 ◽

Cited By ~ 67

Author(s):

Raymond F. Sekula ◽

Andrew M. Frederickson ◽

Peter J. Jannetta ◽

Matthew R. Quigley ◽

Khaled M. Aziz ◽

...

Keyword(s):

Systematic Review ◽

Trigeminal Neuralgia ◽

Elderly Patients ◽

Prospective Study ◽

Microvascular Decompression ◽

Cranial Nerve ◽

Meta Analysis ◽

Complication Rates ◽

Significant Difference

Object Because the incidence of trigeminal neuralgia (TN) increases with age, neurosurgeons frequently encounter elderly patients with this disorder. Although microvascular decompression (MVD) is the only etiological therapy for TN with the highest initial efficacy and durability of all treatments, it is nonetheless associated with special risks (cerebellar hematoma, cranial nerve injury, stroke, and death) not seen with the commonly performed ablative procedures. Thus, the safety of MVD in the elderly remains a concern. This prospective study and systematic review with meta-analysis was conducted to determine whether MVD is a safe and effective treatment in elderly patients with TN. Methods In this prospectively conducted analysis, 36 elderly patients (mean age 73.0 ± 5.9 years) and 53 nonelderly patients (mean age 52.9 ± 8.8 years) underwent MVD over the study period. Outcome and complication data were recorded. The authors also conducted a systematic review of the English literature published before December 2009 and providing outcomes and complications of MVD in patients with TN above the age of 60 years. Pooled complication rates of stroke, death, cerebellar hematoma, and permanent cranial nerve deficits were analyzed. Results Thirty-one elderly patients (86.1%) reported an excellent outcome after MVD (mean follow-up 20.0 ± 7.0 months). Twenty-five elderly patients with Type 1 TN were compared with 26 nonelderly patients with Type 1 TN, and no significant difference in outcomes was found (p = 0.046). Three elderly patients with Type 2a TN were compared with 12 nonelderly patients with Type 2a TN, and no significant difference in outcomes was noted (p = 1.0). Eight elderly patients with Type 2b TN were compared with 15 nonelderly patients with Type 2b TN, and no significant difference in outcomes was noted (p = 0.086). The median length of stay between cohorts was compared, and no significant difference was noted (2 days for each cohort, p = 0.33). There were no CSF leaks, no cerebellar hematomas, no strokes, and no deaths. Eight studies (1334 patients) met the inclusion criteria for the meta-analysis. For none of the complications was the incidence significantly more frequent in elderly patients than in the nonelderly. Conclusions Although patient selection remains important, the authors' experience and the results of this systematic review with meta-analysis suggest that the majority of elderly patients with TN can safely undergo MVD.

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