Gamma Knife stereotactic radiosurgical treatment of idiopathic trigeminal neuralgia: long-term outcome and complications

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Stereotactic radiosurgery (SRS) with the Gamma Knife (GK) is a rapidly emerging surgical modality in the management of medically refractory idiopathic trigeminal neuralgia (TN). The current study examines the long-term outcome in patients with drug-resistant idiopathic TN who underwent GK surgery at the authors‘ institution.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>One hundred and six consecutive patients (38 men and 68 women) with proven medically refractory idiopathic TN were included in this retrospective study. Their ages were 41–82 years (mean 72.3 years). All patients underwent SRS with prescribed maximal radiation doses ranging from 70 to 85 Gy. Isocenters 1–3 were used and plugging was used selectively. The follow-up period was 12–72 months (mean 34.3 months). The patients were divided into 2 groups according to their history of previous surgery.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The initial response rate in patients with no history of previous surgery was 92.9%; in those who had undergone previous surgery, the initial response rate was 85.7%. At the end of the 1st posttreatment year, an excellent outcome was achieved in 82.5% of patients who had not had previous surgery, and in 69.4% of those who had. The respective outcome rates for the 2nd posttreatment year were 78 and 63.5%, respectively. The most common complication was the development of persistent paresthesia, which occurred in 15.8% of patients with no previous surgery and 16.3% of those with previous surgery.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Stereotactic radiosurgery with the GK is a safe and effective treatment option for patients with medically refractory idiopathic TN.</jats:p></jats:sec>

Is It Effective to Raise the Irradiation Dose from 80 to 85 Gy in Gamma Knife Radiosurgery for Trigeminal Neuralgia?

“…Furthermore, the effect of GKS was found to decrease with time, consistently with previous reports [9,26,[31][32][33] . The actuarial rate of favorable outcome was not affected by any radiosurgical parameters, as reported in previous studies [26,28,32] , and a prolonged period of morbidity ( 1 30 months) was a unique predictive factor for the actuarial rate.…”

Treatment Options in Trigeminal Neuralgia an Update

“…Park et al, found no significant differences in radiation dose, time to initial response, recurrence or pain relief when GKS was used as a primary or a secondary procedure for idiopathic TN (77). Some studies report higher failure rate when GKS is performed as a secondary procedure (76,78). It was also found to be an effective treatment option for trigeminal neuralgia patients with multiple sclerosis (79), but the study was based on a small group of patients.…”

Clinical, Anatomo-Radiological and Dosimetric Features Influencing Pain Outcome After Gamma Knife Treatment of Trigeminal Neuralgia

“…A higher integral dose can be augmented either using of two isocenters or using of plugs. Morbidini-Gaffney (Morbidini-Gaffney, 2006) and Alpert (Alpert, 2005) found better pain control using two isocenters, Conversely Flickinger ) in a randomized prospective study found no differences using one or two isocenters and Fountas (Fountas, 2007) reports no differences using one, 2 or 3 isocenters. Nevertheless, nerve dysfunction was more important in the group of patients treated with multiple isocenters.…”

“…Fountas (Fountas, 2007), reports this phenomenon in 79% of the treated patients. This finding confirms the zone that received the irradiation.…”

“…(Brisman, 2000a;Dellanretti, 2008;Dhople, 2009;Little, 2008;Longhi, 2007;Pan, 2010;Petit, 2003;Pollock, 2002;Regís, 2009;Tawk, 2005;Verheul, 2010;Young 1997), lesses number of articles found no influence of this variable (Dhople, 2009 ;Fountas, 2007;Hayashi, 2009;Massager, 2007a;Park, 2011;Reisenburger, 2010;Sheehan, 2005). Only one study showed better pain outcome in those patients previously treated (Rogers, 2000).…”