Gamma knife radiosurgery using 90 Gy for trigeminal neuralgia

Abstract

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 Trigeminal Neuralgia: A Single-Center Experience in 179 Patients With Varied Dose Prescriptions and Treatment Plans

“…In patients with essential TN, more than 88% of patients attained significant relief, similar to prior reports on gamma knife radiosurgery (9,11,(19)(20)(21)23). Prior treatment was the primary factor associated with poor results.…”

“…In this study, we found a trend toward increased numbness with increased dose. However, as in other reports, the majority of patients described their change in facial sensation as an intermittent tingling or limited and minor hypesthesia (20,30).…”

“…This was sustained in 121 patients (55%) at a median follow-up of 2 years. At other centers, significant pain relief at follow-up ranges from 70% to 95% (9,17,(20)(21)(22)(23)(24). We reported our initial series on 60 TN patients treated with a dedicated D-LINAC in 2003 (12,16) and other centers have now demonstrated equally positive results (25)(26)(27)(28).…”

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).…”