Decreased Probability of Initial Pain Cessation in Classic Trigeminal Neuralgia Treated With Gamma Knife Surgery in Case of Previous Microvascular Decompression

Tuleasca, Constantin; Carron, Romain; Resseguier, Noémie; Donnet, Anne; Roussel, Philippe; Gaudart, Jean; Levivier, Marc; Régis, Jean

doi:10.1227/neu.0000000000000739

Cited by 20 publications

(7 citation statements)

References 39 publications

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“…The duration of pain before Gamma Knife (p = 0.73), the sex of the patient (p = 0.56) and the effect of a prior surgery (p = 0.33 for one, p = 0.55 for two, p = 0.09 for three or more) were not statistically significant. Previous MVD (p = 0.01) was already advocated as a negative predictor for initial pain relief in one of our previous studies [28] and applies also to the current one. …”

Section: Resultssupporting

confidence: 71%

“…The mechanisms of action of radiosurgery for TN are not completely elucidated, but it seems to primarily affect myelin at the radiosurgery site [23]. Clinical evidence exists nowadays for factors that predict for a lower degree of radiosurgery efficacy, including multiple sclerosis [13], previous MVD [24], previous surgical treatment on the same side [8] or atypical TN.…”

Section: Discussionmentioning

confidence: 99%

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The Very Long-Term Outcome of Radiosurgery for Classical Trigeminal Neuralgia

Régis

Tuleasca

Resseguier

et al. 2016

Stereotact Funct Neurosurg

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Background: Radiosurgery is one of the neurosurgical alternatives for intractable trigeminal neuralgia (TN). Objective: Although acceptable short-/mid-term outcomes have been reported, long-term results have not been well documented. Methods: We report the long-term results in 130 patients who underwent radiosurgery for classical TN and were subsequently monitored through at least 7 years (median = 9.9, range = 7-14.5) of follow-up. Results: The median age was 66.5 years. A total of 122 patients (93.8%) became pain free (median delay = 15 days) after the radiosurgery procedure (Barrow Neurological Institute, BNI class I-IIIa). The probability of remaining pain free without medication at 3, 5, 7 and 10 years was 77.9, 73.8, 68 and 51.5%, respectively. Fifty-six patients (45.9%) who were initially pain free experienced recurrent pain (median delay = 73.1 months). However, at 10 years, of the initial 130 patients, 67.7% were free of any recurrence requiring new surgery (BNI class I-IIIa). The new hypesthesia rate was 20.8% (median delay of onset = 12 months), and only 1 patient (0.8%) reported very bothersome hypesthesia. Conclusions: The long-term results were comparable to those from our general series (recently published), and the high probability of long-lasting pain relief and rarity of consequential complications of radiosurgery may suggest it as a first- and/or second-line treatment for classical, drug-resistant TN.

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Section: Resultssupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

The Very Long-Term Outcome of Radiosurgery for Classical Trigeminal Neuralgia

Régis

Tuleasca

Resseguier

et al. 2016

Stereotact Funct Neurosurg

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“…Positive predictors before RS are an increased age, 83,121 age more than 70 years, 43,57 and typical pain. 77 Negative predictors before RS include multiple sclerosis, 13,62,76,90,112,137 prior surgery 57,74,82,103,106,132 or ablative procedures, 86,132 an atypical component, 82,118 appearance or aggravation of a sensory deficit, 82 previous MVD, 66,75,120,133 age under 70 years, 132 age under 60 years, 112 distance between the isocenter and the exit of the nerve > 8 mm, 112 and diabetes mellitus. 83 Later pain relief maintenance following RS has been positively associated with new facial numbness 63,106,118,132 and no past surgery 25 and negatively associated with a better initial response.…”

Section: General Aspectsmentioning

confidence: 99%

“…Two retrospective studies address the issue of GKS following MVD. 75,133 Little et al 75 made an analysis of a subgroup of 24 patients treated with GKS after a previous MVD. The authors stated that at 5 years, only 12% of patients with prior MVD had FFP compared with 25% who had no history of MVD (p = 0.029).…”

Section: Neurovascular Conflict and Its Effect On Pain Reliefmentioning

confidence: 99%

“…The authors stated that at 5 years, only 12% of patients with prior MVD had FFP compared with 25% who had no history of MVD (p = 0.029). Tuleasca et al 133 compared 54 prior-MVD cases with a cohort of 497 cases with more than 1 year of follow-up (range 14.1-144.6 months). The patients were treated at a retrogasserian target with a median dose of 85 Gy (range 70-90 Gy).…”

Section: Neurovascular Conflict and Its Effect On Pain Reliefmentioning

confidence: 99%

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Stereotactic radiosurgery for trigeminal neuralgia: a systematic review

Tuleasca

Régis

Sahgal

et al. 2019

Journal of Neurosurgery

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134

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OBJECTIVES The aims of this systematic review are to provide an objective summary of the published literature specific to the treatment of classical trigeminal neuralgia with stereotactic radiosurgery (RS) and to develop consensus guideline recommendations for the use of RS, as endorsed by the International Society of Stereotactic Radiosurgery (ISRS). METHODS The authors performed a systematic review of the English-language literature from 1951 up to December 2015 using the Embase, PubMed, and MEDLINE databases. The following MeSH terms were used in a title and abstract screening: "radiosurgery" AND "trigeminal." Of the 585 initial results obtained, the authors performed a full text screening of 185 studies and ultimately found 65 eligible studies. Guideline recommendations were based on level of evidence and level of consensus, the latter predefined as at least 85% agreement among the ISRS guideline committee members. RESULTS The results for 65 studies (6461 patients) are reported: 45 Gamma Knife RS (GKS) studies (5687 patients [88%]), 11 linear accelerator (LINAC) RS studies (511 patients [8%]), and 9 CyberKnife RS (CKR) studies (263 patients [4%]). With the exception of one prospective study, all studies were retrospective. The mean maximal doses were 71.1-90.1 Gy (prescribed at the 100% isodose line) for GKS, 83.3 Gy for LINAC, and 64.3-80.5 Gy for CKR (the latter two prescribed at the 80% or 90% isodose lines, respectively). The ranges of maximal doses were as follows: 60-97 Gy for GKS, 50-90 Gy for LINAC, and 66-90 Gy for CKR. Actuarial initial freedom from pain (FFP) without medication ranged from 28.6% to 100% (mean 53.1%, median 52.1%) for GKS, from 17.3% to 76% (mean 49.3%, median 43.2%) for LINAC, and from 40% to 72% (mean 56.3%, median 58%) for CKR. Specific to hypesthesia, the crude rates (all Barrow Neurological Institute Pain Intensity Scale scores included) ranged from 0% to 68.8% (mean 21.7%, median 19%) for GKS, from 11.4% to 49.7% (mean 27.6%, median 28.5%) for LINAC, and from 11.8% to 51.2% (mean 29.1%, median 18.7%) for CKR. Other complications included dysesthesias, paresthesias, dry eye, deafferentation pain, and keratitis. Hypesthesia and paresthesia occurred as complications only when the anterior retrogasserian portion of the trigeminal nerve was targeted, whereas the other listed complications occurred when the root entry zone was targeted. Recurrence rates ranged from 0% to 52.2% (mean 24.6%, median 23%) for GKS, from 19% to 63% (mean 32.2%, median 29%) for LINAC, and from 15.8% to 33% (mean 25.8%, median 27.2%) for CKR. Two GKS series reported 30% and 45.3% of patients who were pain free without medication at 10 years. CONCLUSIONS The literature is limited in its level of evidence, with only one comparative randomized trial (1 vs 2 isocenters) reported to date. At present, one can conclude that RS is a safe and effective therapy for drug-resistant trigeminal neuralgia. A number of consensus statements have been made and endorsed by the ISRS.

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