Microvascular Decompression for Trigeminal Neuralgia in Patients with and without Prior Stereotactic Radiosurgery

Chen, Joseph C.T.

doi:10.1016/j.wneu.2011.09.029

Cited by 17 publications

(12 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To date, several studies have addressed the alleged technical difficulties when MVD is performed after previous GKS. 1,2,5,22,24,34,35 To the best of our knowledge, there is currently no study describing GKS after MVD or the doseplanning difficulties regarding the GKS trigeminal nerve targeting after previous MVD. However, clinicians must cope with this particular situation.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2015

View full text Add to dashboard Cite

Patients with previous MVD showed a significantly lower probability of initial pain cessation compared with our global population with classic TN (P = .01). The toxicity was low (only 9.1% hypoesthesia); furthermore, no patient reported bothersome hypoesthesia. However, the probability of maintaining pain relief without medication was 44.3% at 10 years, similar to our global series of classic TN (P = .85).

show abstract

Section: Discussionmentioning

confidence: 99%

“…The population of recurrent TN patients with prior MVD was deemed especially relevant because MVD is regarded as the reference technique. Moreover, although the outcomes of MVD after previous GKS are well established, 1,2,5,[19][20][21][22][23][24] outcomes of GKS after previous MVD have not been reported so far.…”

mentioning

confidence: 99%

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

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Depending on the study, MVD recurrence rates on long-term basis range between 15% and 35%. [2][3][4]7,8,[10][11][12]18,28,30,52,55,56 For percutaneous techniques, such as thermocoagulation, some trials reported a 57.7% pain-free response after a first procedure and up to 94% at 5-year follow-up after a second procedure. 31 Facial numbness has been reported to occur in between 58% and 79% of patients.…”

Section: Discussionmentioning

confidence: 99%

Repeat Gamma Knife surgery for recurrent trigeminal neuralgia: long-term outcomes and systematic review

Tuleasca

Carron

Resseguier³

et al. 2014

JNS

View full text Add to dashboard Cite

ObjectThe purpose of this study was to establish the safety and efficacy of repeat Gamma Knife surgery (GKS) for recurrent trigeminal neuralgia (TN).MethodsUsing the prospective database of TN patients treated with GKS in Timone University Hospital (Marseille, France), data were analyzed for 737 patients undergoing GKS for TN Type 1 from July 1992 to November 2010. Among the 497 patients with initial pain cessation, 34.4% (157/456 with ≥ 1-year follow-up) experienced at least 1 recurrence. Thirteen patients (1.8%) were considered for a second GKS, proposed only if the patients had good and prolonged initial pain cessation after the first GKS, with no other treatment alternative at the moment of recurrence. As for the first GKS, 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 90 Gy (range 70–90 Gy) was delivered. Data for 9 patients with at least 1-year followup were analyzed. A systematic review of literature was also performed, and results are compared with those of the Marseille study.ResultsThe median time to retreatment in the Marseille study was 72 months (range 12–125 months) and in the literature it was 17 months (range 3–146 months). In the Marseille study, the median follow-up period was 33.9 months (range 12–96 months), and 8 of 9 patients (88.9%) had initial pain cessation with a median of 6.5 days (range 1–180 days). The actuarial rate for new hypesthesia was 33.3% at 6 months and 50% at 1 year, which remained stable for 7 years. The actuarial probabilities of maintaining pain relief without medication at 6 months and 1 year were 100% and 75%, respectively, and remained stable for 7 years. The systematic review analyzed 20 peer-reviewed studies reporting outcomes for repeat GKS for recurrent TN, with a total of 626 patients. Both the selection of the cases for retreatment and the way of reporting outcomes vary widely among studies, with a median rate for initial pain cessation of 88% (range 60%–100%) and for new hypesthesia of 33% (range 11%–80%).ConclusionsResults from the Marseille study raise the question of surgical alternatives after failed GKS for TN. The rates of initial pain cessation and recurrence seem comparable to, or even better than, those of the first GKS, according to different studies, but toxicity is much higher, both in the Marseille study and in the published data. Neither the Marseille study data nor literature data answer the 3 cardinal questions regarding repeat radiosurgery in recurrent TN: which patients to retreat, which target is optimal, and which dose to use.

show abstract

“…After careful evaluation, a total of 22 articles were selected for data retrieval and final analysis. 3,[5][6][7][8][11][12][13][14][15][16][18][19][20][21][22][23]25,26,[28][29][30] Our search failed to identify any study that had directly compared the outcome between repeat GKRS and MVD in patients with prior GKRS failure. Therefore, for purposes of analysis, we grouped the studies into two groups: the first group included studies describing outcome after repeat GKRS (n = 17) and the second group included studies describing outcome after MVD (n = 5).…”

Section: Systematic Review and Meta-analysismentioning

confidence: 99%

“…1 However, recently, Chen has argued that prior therapy does not adversely affect pain outcome after MVD. 5 Still, most clinicians would agree that the response of MVD as a salvage procedure is not as good as it is for a primary procedure. The primary concern for MVD in a previously irradiated patient is the possible alteration of the nerve-vessel anatomy with high incidence of adhesions, scarring, etc., which may make the surgical decompression more challenging.…”

Section: Role Of Repeat Gkrs In Tnmentioning

confidence: 99%

Repeat Gamma Knife radiosurgery versus microvascular decompression following failure of GKRS in trigeminal neuralgia: a systematic review and meta-analysis

Patra¹,

Savardekar²,

Dossani³

et al. 2019

Journal of Neurosurgery

View full text Add to dashboard Cite

OBJECTIVEGamma Knife radiosurgery (GKRS) has emerged as a promising treatment modality for patients with classical trigeminal neuralgia (TN); however, considering that almost half of the patients experience post-GKRS failure or lesion recurrence, a repeat treatment is typically necessary. The existing literature does not offer clear evidence to establish which treatment modality, repeat GKRS or microvascular decompression (MVD), is superior. The present study aimed to compare the overall outcome of patients who have undergone either repeat GKRS or MVD after failure of their primary GKRS; the authors do so by conducting a systematic review and meta-analysis of the literature and analysis of data from their own institution.METHODSThe authors conducted a systematic review and meta-analysis of the PubMed, Cochrane Library, Web of Science, and CINAHL databases to identify studies describing patients who underwent either repeat GKRS or MVD after initial failed GKRS for TN. The primary outcomes were complete pain relief (CPR) and adequate pain relief (APR) at 1 year. The secondary outcomes were rate of postoperative facial numbness and the retreatment rate. The pooled data were analyzed with R software. Bias and heterogeneity were assessed using funnel plots and I2 tests, respectively. A retrospective analysis of a series of patients treated by the authors who underwent repeat GKRS or MVD after post-GKRS failure or relapse is presented.RESULTSA total of 22 studies met the selection criteria and were included for final data retrieval and meta-analysis. The search did not identify any study that had directly compared outcomes between patients who had undergone repeat GKRS versus those who had undergone MVD. Therefore, the authors’ final analysis included two groups: studies describing outcome after repeat GKRS (n = 17) and studies describing outcome after MVD (n = 5). The authors’ institutional study was the only study with direct comparison of the two cohorts. The pooled estimates of primary outcomes were APR in 83% of patients who underwent repeat GKRS and 88% of those who underwent MVD (p = 0.49), and CPR in 46% of patients who underwent repeat GKRS and 72% of those who underwent MVD (p = 0.02). The pooled estimates of secondary outcomes were facial numbness in 32% of patients who underwent repeat GKRS and 22% of those who underwent MVD (p = 0.11); the retreatment rate was 19% in patients who underwent repeat GKRS and 13% in those who underwent MVD (p = 0.74). The authors’ institutional study included 42 patients (repeat GKRS in 15 and MVD in 27), and the outcomes 1 year after retreatment were APR in 80% of those who underwent repeat GKRS and 81% in those who underwent MVD (p = 1.0); CPR was achieved in 47% of those who underwent repeat GKRS and 44% in those who underwent MVD (p = 1.0). There was no difference in the rate of postoperative facial numbness or retreatment.CONCLUSIONSThe current meta-analysis failed to identify any superiority of one treatment over the other with comparable outcomes in terms of APR, postoperative facial numbness, and retreatment rates. However, MVD was shown to provide a better chance of CPR compared with repeat GKRS.

show abstract

Microvascular Decompression for Trigeminal Neuralgia in Patients with and without Prior Stereotactic Radiosurgery

Cited by 17 publications

References 25 publications

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

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

Repeat Gamma Knife surgery for recurrent trigeminal neuralgia: long-term outcomes and systematic review

Repeat Gamma Knife radiosurgery versus microvascular decompression following failure of GKRS in trigeminal neuralgia: a systematic review and meta-analysis

Contact Info

Product

Resources

About