A successful case of multiple stereotactic radiosurgeries for ipsilateral recurrent trigeminal neuralgia

Daugherty, Emily; Bhavsar, S.; Hahn, Seung S.; Bassano, Daniel A.; Hall, Walter A.

doi:10.3171/2014.9.jns13959

Cited by 4 publications

(3 citation statements)

References 37 publications

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“…GKRS has been reported in one small retrospective series, as well as in cases reports. [7][8][9][10] Here, we report the largest series to date of patients who have undergone a third GKRS for repeated treatment failure. Our results showed that a third GKRS is generally an effective treatment, with 18 of 22 cases attaining pain relief (i.e., BNI pain intensity score ≤ IIIb).…”

Section: Figmentioning

confidence: 96%

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Results of a third Gamma Knife radiosurgery for trigeminal neuralgia

Helis¹,

Hughes²,

Munley³

et al. 2021

Journal of Neurosurgery

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OBJECTIVEGamma Knife radiosurgery (GKRS) is a commonly used procedure for medically refractory trigeminal neuralgia (TN), with repeat GKRS routinely done in cases of pain relapse. The results of a third GKRS in cases of further pain relapse have not been well described. In this study, the authors report the largest series of patients treated with a third GKRS for TN to date.METHODSRetrospective review of institutional electronic medical records and a GKRS database was performed to identify patients who had been treated with a third GKRS at the authors’ institution in the period from 2010 to 2018. Telephone interviews were used to collect long-term follow-up data. Pain outcomes were measured using the Barrow Neurological Institute (BNI) pain intensity scale, with a score ≤ IIIb indicating successful treatment.RESULTSTwenty-two nerves in 21 patients had sufficient follow-up to determine BNI pain score outcomes. Eighteen of 22 cases had a successful third GKRS, with a median durability of pain relief of 3.88 years. There was no significant difference in the durability of pain relief after a third GKRS compared with those of institutional historical controls of prior series of first and second GKRS procedures. Ten cases had new or worsening facial numbness, with 1 case being bothersome. Four cases of toxicity other than facial numbness were reported, including 1 case of corneal abrasions and possible neurotrophic keratopathy. No cases of anesthesia dolorosa were reported. No factors predicting treatment success or the durability of pain relief were identified. Nonnumbness toxicity was more common in those with a proximally placed shot at the third GKRS.CONCLUSIONSA third GKRS is an effective treatment option for TN patients who have pain relapse after repeat GKRS. Pain outcomes of a third GKRS are similar to those following a first or second GKRS. Toxicity is tolerable in patients with a distally placed shot at the third GKRS.

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Section: Figmentioning

confidence: 96%

“…5,6 Additional GKRS for multiply recurrent pain is not well described, with the literature limited to case reports and a single retrospective series thus far. [7][8][9][10] In the present retrospective review, we aim to report the outcomes of patients who underwent at least three GKRS procedures to a single trigeminal nerve for medically refractory TN.…”

mentioning

confidence: 99%

Results of a third Gamma Knife radiosurgery for trigeminal neuralgia

Helis¹,

Hughes²,

Munley³

et al. 2021

Journal of Neurosurgery

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“…When pain recurs after three or more years, many GK patients undergo repeat SRS treatment, and numerous series using GK show that the outcome of a second SRS treatment is similar to the initial treatment with 61% excellent or good results within the initial 24 months but with a higher incidence of residual facial numbness [ 34 - 42 ]. There are even case reports of third SRS treatments within the dose restraints of multiple treatments with a debate of the proper dose relative to risk of secondary effects on the adjacent brainstem and the trigeminal nerve and risk of increased facial numbness [ 42 , 43 ]. Although there are numerous reports of series of patients treated with recurrent pain with GK, there are no series reporting the use of CK for recurrent trigeminal neuralgia after initial successful SRS treatment, which is the focus of this report.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of CyberKnife Radiosurgery for Recurrent Trigeminal Neuralgia

Berti¹,

Ibars²,

Wu³

et al. 2018

Cureus

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Stereotactic radiosurgery (SRS) has evolved as an accepted treatment for medication resistant trigeminal neuralgia. Initial results are very good but follow-up over three to five years shows a gradual return of pain in up to 50% of treated patients, often requiring further treatment. The results with repeat SRS using the isocentric Gamma Knife (GK) (Elekta, Stockholm, Sweden), especially in patients having initially good results, are very similar to the outcomes after the initial treatment although there is an increased risk of residual facial numbness secondary to the additional radiation dose to the trigeminal nerve. However, after 2000, non-isocentric SRS systems began to be used for treating trigeminal neuralgia including the CyberKnife (CK) (Accuray, Sunnyvale, California) as well as various linear accelerator (LINAC) based systems. This report specifically examines a series of recurrent trigeminal cases treated by the same group of physicians with the CK system. Similar doses and locations on the trigeminal nerve and/or the root entry zone were used for both initial and repeat SRS treatment regardless of system used. Although there are numerous series reporting the use of GK for recurrent treatment for recurrent trigeminal neuralgia, there are no series reviewing the results and long-term effectiveness using CK for repeat SRS for recurrent trigeminal pain. We reviewed 23 cases that had initial treatment for trigeminal neuralgia either surgically or with SRS with either the GK or CK and then a later second procedure only with CK. The follow-up after the second CK SRS ranged from three to 13 years found that the results are very similar to the multiple reports in the literature describing second or third SRS treatments with the GK. Results of repeat radiosurgery treatment of recurrent trigeminal neuralgia appear to be independent of the system used and are primarily based on proper target and dose to the trigeminal nerve.

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