Leksell Gamma Knife Treatment of Tic Douloureux

Rand, Robert W.; Jacques, David; Melbye, Roy Wilbur; Copcutt, Brian; Levenick, M.N.; Fisher, M.R.

doi:10.1159/000100663

Cited by 99 publications

(52 citation statements)

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“…Although the results of this study show that RTR is very effective and has limited side effects, avoiding any surgical intervention should be a primary consideration [9][10][11][12]. Even the low rate of side effects found in this study can be significantly debilitating in some cases (dysesthesia, analgesia, hypoalgesia), medical therapy before surgical consideration is therefore necessary and can be effective in many patients.…”

Section: Discussionmentioning

confidence: 91%

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Percutaneous Radiofrequency Rhizotomy in Treatment of Trigeminal neuralgia: A Prospective Study

Nanjappa

Kumaraswamy

Keerthi

et al. 2012

J. Maxillofac. Oral Surg.

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Introduction Trigeminal neuralgia (TN) often called as ''Tic douloureux'' is a syndrome characterized by paroxysmal facial pain, is one of the most painful and debilitating craniofacial pain disorders. The controversy regarding the etiology and treatment of TN still exists. Objective To evaluate the effectiveness of percutaneous radiofrequency rhizotomy (PRR) for TN, after failure of pharmacological management. Method A nonrandomized, non comparative, descriptive, in vivo study of 15 patients with TN of maxillary and mandibular divisions of trigeminal nerve and patients with pain refractory to pharmacological management were done. It was performed as an O.P.D procedure. A routine follow up was done in all cases for 1 year. Results In a total of 15 patients, 8 female and 7 male patients were enrolled for the study. Early pain relief (immediately, postoperatively to 6 month) classified as excellent or good (successful), occurred in 12 of 15 patients (80 %). Fair or poor pain relief (unsuccessful) occurred in three patients (20 %).There was no mortalities and no major morbidity. Summary It was found that surgical treatment with PRR is a safe and effective way to manage patients with TN in whom pharmacologic therapy is either ineffective or not tolerated, with low side effects which are well tolerated.

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Section: Discussionmentioning

confidence: 91%

“…It is a minimally invasive and effective procedure that is especially indicated in older patients with that is Brown and Gouda [2] Burchiel et al [3] Rand [10] confined to the maxillary and mandibular divisions of trigeminal nerve with a low rate of recurrence. 2.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Radiofrequency Rhizotomy in Treatment of Trigeminal neuralgia: A Prospective Study

Nanjappa

Kumaraswamy

Keerthi

et al. 2012

J. Maxillofac. Oral Surg.

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“…28,31 A cornerstone paper was the multicentric study of Kondziolka et al, which appeared in 1996 12 and generated a profound paradigm shift in radiosurgical practice. 33 The reappraisal of radiosurgery for TN in the 1990s was made possible by the development of high-resolution MRI, which enabled the proper visualization of the cisternal portion of cranial nerve V. 30,33 Radiosurgery is currently regarded as the least invasive neurosurgical approach for TN.…”

Section: Discussionmentioning

confidence: 99%

Long-term safety and efficacy of Gamma Knife surgery in classical trigeminal neuralgia: a 497-patient historical cohort study

Régis

Tuleasca

Resseguier

et al. 2016

JNS

143

126

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OBJectiVe Gamma Knife surgery (GKS) is one of the surgical alternatives for the treatment of drug-resistant trigeminal neuralgia (TN). This study aims to evaluate the safety and efficacy of GKS in a large population of patients with TN with very long-term clinical follow-up. methOdS Between July 1992 and November 2010, 737 patients presenting with TN were treated using GKS. Data were collected prospectively and were further retrospectively evaluated at Timone University Hospital. The frequency and severity of pain, as well as trigeminal nerve function, were evaluated before GKS and regularly thereafter. Radiosurgery using the Gamma Knife (model B, C, 4C, or Perfexion) was performed with the help of both MR and CT targeting. A single 4-mm isocenter was positioned in the cisternal portion of the trigeminal nerve at a median distance of 7.6 mm (range 4-14 mm) anterior to the emergence of the nerve (retrogasserian target). A median maximum dose of 85 Gy (range 70-90 Gy) was prescribed. reSultS The safety and efficacy are reported for 497 patients with medically refractory classical TN who were never previously treated by GKS and had a follow-up of at least 1 year. The median age in this series was 68.3 years (range 28.1-93.2 years). The median follow-up period was 43.8 months (range 12-174.4 months). Overall, 456 patients (91.75%) were initially pain free in a median time of 10 days (range 1-180 days). Their actuarial probabilities of remaining pain free without medication at 3, 5, 7, and 10 years were 71.8%, 64.9%, 59.7%, and 45.3%, respectively. One hundred fifty-seven patients (34.4%) who were initially pain free experienced at least 1 recurrence, with a median delay of onset of 24 months (range 0.6-150.1 months). However, the actuarial rate of maintaining pain relief without further surgery was 67.8% at 10 years. The hypesthesia actuarial rate at 5 years was 20.4% and at 7 years reached 21.1%, but remained stable until 14 years with a median delay of onset of 12 months (range 1-65 months). Very bothersome facial hypesthesia was reported in only 3 patients (0.6%). cONcluSiONS Retrogasserian GKS proved to be safe and effective in the long term and in a very large number of patients. Even if the probability of long-lasting effects may be modest compared with microvascular decompression, the rarity of complications prompts discussion of using GKS as the pragmatic surgical first- or second-intention alternative for classical TN. However, a randomized trial, or at least a case-matched control study, would be required to compare with microvascular decompression.http://thejns.org/doi/abs/10.3171/2015.2.JNS142144

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“…Gamma Knife Surgery (GKS) was implemented in 1968, and gained further interest for the treatment of TN in the early 1990s, with the use of magnetic resonance imaging (MRI) and limitations of other more invasive techniques [8,9]. In 1993, Rand et al [9] proposed to move the target from the gasserian ganglion to the cisternal segment of the nerve. For a short time afterwards, Lindquist [10] promoted the idea of targeting the nerve at its emergence from the brainstem [dorsal root entry zone (DREZ)], with a dose of 70 Gy.…”

Section: Tnmentioning

confidence: 99%

Gamma Knife for Functional Diseases

Régis

2014

Neurotherapeutics

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Leksell Gamma Knife Treatment of Tic Douloureux

Cited by 99 publications

References 0 publications

Percutaneous Radiofrequency Rhizotomy in Treatment of Trigeminal neuralgia: A Prospective Study

Percutaneous Radiofrequency Rhizotomy in Treatment of Trigeminal neuralgia: A Prospective Study

Long-term safety and efficacy of Gamma Knife surgery in classical trigeminal neuralgia: a 497-patient historical cohort study

Gamma Knife for Functional Diseases

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