Gamma knife radiosurgery for primary management for trigeminal neuralgia

Abstract

Object. The purpose of this study was to assess the efficacy of gamma knife radiosurgery (GKS) as the primary rather than secondary management for trigeminal neuralgia. Methods. Eighty-two patients underwent GKS as their first neurosurgical intervention (Group A), and 90 patients underwent GKS following a different procedure (Group B). All GKS patients were treated with a maximum dose of 75 Gy. The single 4-mm isocenter was placed close to the junction of the trigeminal nerve and the brainstem. Six-month follow up was available for 126 patients and 12-month follow up for 84 patients. Excellent (no pain and no medicine) or good (at least 50% reduction in pain and less medicine) relief was more likely to occur in Group A than in Group B patients 6 and 12 months following GKS for trigeminal neuralgia (p = 0.058). Excellent or good results were also more likely in patients with trigeminal neuralgia without multiple sclerosis (MS) (p = 0.042). The number and type of procedures performed prior to GKS, the interval between the last procedure and GKS, and the interval from first symptom to GKS (within Groups A and B) did not affect 6-month outcome. The interval between first symptom and GKS was shorter in Group A patients without MS (87 months) than in Group B (148 months; p < 0.004). There were no significant differences between Group A and B patients with regard to sex, age, or laterality. Conclusions. Patients with trigeminal neuralgia who are treated with GKS as primary management have better pain relief than those treated with GKS as secondary management. Patients are more likely to have pain relief if they do not have MS.

Trigeminal neuralgia and other neuropathic pain syndromes of the head and face

“…Stereotactic radiosurgery, initially used only for cases refractory to other treatments, is being used as first-line therapy at some institutions. Although relatively new compared with the other treatments, an increasing number of reports describe good success rates and acceptable rates of recurrence [44][45][46][47]. Obviously, long-term results are unavailable, but more patients are attracted to such a "noninvasive" treatment.…”

Outcomes of gamma knife radiosurgery for trigeminal neuralgia after a minimum 3-year follow-up

“…The relationship between higher radiation dose and risk of trigeminal nerve dysfunction has been reported. 16,17 However, in our series, all patients with complications were treated with 80 Gy. Only one patient treated with 90 Gy had no complications.…”

“…5 Since then, there have been a number of reports on the efficacy and safety of GKRS for TN. 2,[4][5][6][7][8][9][10][11][12][13][14][15][16][17] However, many studies have reported initial pain response without long-term follow-up after GKRS. Analysis of long-term results of GKRS should be performed for further investigation of treatment outcome.…”

Long-Term Outcome of Gamma Knife Radiosurgery for Treatment of Typical Trigeminal Neuralgia

“…Since the first multi-institutional study by Kondziolka et al (22) suggested a standard method and dose-selection guidelines for radiosurgery for TN, many studies have investigated the safety and efficacy of radiosurgery for TN (12,(14)(15)(16)(17)(18)(19)(20)(21). These data have demonstrated that radiosurgery is a safe technique for the management of TN, because trigeminal sensory disturbance, the main complication of radiosurgery for TN, only developed in approximately 10% of the patients (10), and the rate of immediate pain relief seemed to be comparable to those of other surgical procedures.…”

“…In particular, elderly patients with TN and concurrent medical illness can avoid the mortality and morbidity risks associated with surgical interventions by undergoing radiosurgery. In addition, radiosurgery has been reported to provide successful initial pain relief at a rate of 80-90%, usually within 6-12 months after radiosurgery, and this rate is comparable to the rates of other treatments (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). However, few reports have been published concerning the longterm outcomes after radiosurgery for TN, and few studies have investigated the prognostic factors of clinical outcome after radiosurgery for TN (11,13).…”