Multiple Sclerosis-Related Trigeminal Neuralgia: A Prospective Series of 43 Patients Treated with Gamma Knife Surgery with More than One Year of Follow-Up

Tuleasca, Constantin; Carron, Romain; Resseguier, Noémie; Donnet, Anne; Roussel, Philippe; Gaudart, Jean; Levivier, Marc; Régis, Jean

doi:10.1159/000362173

Cited by 50 publications

(24 citation statements)

References 26 publications

(39 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…First, the populations of patients were heterogeneous at baseline, in terms of previous surgeries (highly variable numbers and types) and inclusion of atypical cases and multiple sclerosis, 1,32,63 which are reputed to have a different initial pain cessation outcomes. 58 Second, there was no uniformity of patient selection criteria for retreatment. Third, outcomes were assessed differently; quality of life issues were reported sporadically 24 and, if so, on different scales.…”

Section: Systematic Reviewmentioning

confidence: 99%

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

Tuleasca

Carron

Resseguier³

et al. 2014

JNS

Self Cite

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

Section: Systematic Reviewmentioning

confidence: 99%

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

Tuleasca

Carron

Resseguier³

et al. 2014

JNS

Self Cite

View full text Add to dashboard Cite

show abstract

“…The mechanisms of action of radiosurgery for TN are not completely elucidated, but it seems to primarily affect myelin at the radiosurgery site [23]. Clinical evidence exists nowadays for factors that predict for a lower degree of radiosurgery efficacy, including multiple sclerosis [13], previous MVD [24], previous surgical treatment on the same side [8] or atypical TN.…”

Section: Discussionmentioning

confidence: 99%

“…A total of 130 consecutive patients treated between May 1993 and September 2003, all evaluated according to our prospective protocol, were followed up for more than 7 years. Patients with TN secondary to multiple sclerosis [13] or megadolicho-basilar artery compression [14], or having had a second radiosurgery [15], reputed to have more variable responses, were excluded. The Ethics Committee of the Timone University Hospital (CPPRB 1) approved our study.…”

Section: Methodsmentioning

confidence: 99%

The Very Long-Term Outcome of Radiosurgery for Classical Trigeminal Neuralgia

Régis

Tuleasca

Resseguier

et al. 2016

Stereotact Funct Neurosurg

Self Cite

View full text Add to dashboard Cite

Background: Radiosurgery is one of the neurosurgical alternatives for intractable trigeminal neuralgia (TN). Objective: Although acceptable short-/mid-term outcomes have been reported, long-term results have not been well documented. Methods: We report the long-term results in 130 patients who underwent radiosurgery for classical TN and were subsequently monitored through at least 7 years (median = 9.9, range = 7-14.5) of follow-up. Results: The median age was 66.5 years. A total of 122 patients (93.8%) became pain free (median delay = 15 days) after the radiosurgery procedure (Barrow Neurological Institute, BNI class I-IIIa). The probability of remaining pain free without medication at 3, 5, 7 and 10 years was 77.9, 73.8, 68 and 51.5%, respectively. Fifty-six patients (45.9%) who were initially pain free experienced recurrent pain (median delay = 73.1 months). However, at 10 years, of the initial 130 patients, 67.7% were free of any recurrence requiring new surgery (BNI class I-IIIa). The new hypesthesia rate was 20.8% (median delay of onset = 12 months), and only 1 patient (0.8%) reported very bothersome hypesthesia. Conclusions: The long-term results were comparable to those from our general series (recently published), and the high probability of long-lasting pain relief and rarity of consequential complications of radiosurgery may suggest it as a first- and/or second-line treatment for classical, drug-resistant TN.

show abstract

“…Impaired hearing was noted in two patients after MVD.. A total of 180 pwTNMS had undergone SRS procedures in six studies. 9,38,47,49,61,62 The average age of 60 years was significantly higher than those undergone MVD/PSR procedures (52 years). 83.6% of the patients had pain relief after surgery but 51.1% had experienced recurrence during the follow-up period.…”

Section: Tables 4 Herementioning

confidence: 97%

A Systematic Review of the Management of Trigeminal Neuralgia in Patients with Multiple Sclerosis

Zakrzewska

Brathwaite

2018

World Neurosurgery

View full text Add to dashboard Cite

show abstract

Multiple Sclerosis-Related Trigeminal Neuralgia: A Prospective Series of 43 Patients Treated with Gamma Knife Surgery with More than One Year of Follow-Up

Cited by 50 publications

References 26 publications

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

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

The Very Long-Term Outcome of Radiosurgery for Classical Trigeminal Neuralgia

A Systematic Review of the Management of Trigeminal Neuralgia in Patients with Multiple Sclerosis

Contact Info

Product

Resources

About