Outcomes following single-treatment Gamma Knife surgery for trigeminal neuralgia with a minimum 3-year follow-up

Riesenburger, Ron I.; Hwang, Steven W.; Schirmer, Clemens M.; Zerris, Vasilios A.; Wu, Julian K.; Mahn, Kerry; Klimo, Paul; Mignano, John E.; Thompson, C.; Yao, Kevin C.

doi:10.3171/2009.8.jns081706

Cited by 78 publications

(66 citation statements)

References 23 publications

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“…Only 9 patients (11%) developed mild facial numbness, and 5 of these 9 had complete resolution. Reisenburger et al 15 used 80 Gy to the trigeminal nerve root, with the dose to the brainstem surface not exceeding 20 Gy. Mild facial numbness occurred in 35.8% of patients, but was not considered bothersome.…”

Section: Dose Selection and Trigeminal Neuropathymentioning

confidence: 99%

Long-term outcome of high-dose Gamma Knife surgery in treatment of trigeminal neuralgia

Young¹,

Shivazad

Kryscio

et al. 2013

JNS

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Object Despite the widespread use of Gamma Knife surgery (GKS) for trigeminal neuralgia (TN), controversy remains regarding the optimal treatment dose and target site. Among the published studies, only a few have focused on long-term outcomes (beyond 2 years) using 90 Gy, which is in the higher range of treatment doses used (70–90 Gy). Methods The authors followed up on 315 consecutive patients treated with the Leksell Gamma Knife unit using a 4-mm isocenter without blocks. The isocenter was placed on the trigeminal nerve with the 20% isodose line tangential to the pontine surface (18 Gy). At follow-up, 33 patients were deceased; 282 were mailed an extensive questionnaire regarding their outcomes, but 32 could not be reached. The authors report their analysis of the remaining 250 cases. The patients' mean age at the time of survey response and the mean duration of follow-up were 70.8 ± 13.1 years and 68.9 ± 41.8 months, respectively. Results One hundred eighty-five patients (85.6%) had decreased pain intensity after GKS. Modified Marseille Scale (MMS) pain classifications after GKS at follow-up were: Class I (pain free without medication[s]) in 104 (43.7%), Class II (pain free with medication[s]) in 66 (27.7%), Class III (> 90% decrease in pain intensity) in 23 (9.7%), Class IV (50%–90% decrease in pain intensity) in 20 (8.4%), Class V (< 50% decrease in pain intensity) in 11 (4.6%), and Class VI (pain becoming worse) in 14 (5.9%). Therefore, 170 patients (71.4%) were pain free (Classes I and II) and 213 (89.5%) had at least 50% pain relief. All patients had pain that was refractory to medical management prior to GKS, but only 111 (44.4%) were being treated with medication at follow-up (p < 0.0001). Eighty patients (32.9%) developed numbness after GKS, and 74.5% of patients with numbness had complete pain relief. Quality of life and patient satisfaction on a 10-point scale were reported at mean values (± SD) of 7.8 ± 3.1 and 7.7 ± 3.4, respectively. Most of the patients (87.7%) would recommend GKS to another patient. Patients with prior surgical treatments had increased latency to pain relief and were more likely to continue medicines (p < 0.05). Moreover, presence of altered facial sensations prior to radiosurgery was associated with higher pain intensity, longer pain episodes, more frequent pain attacks, worse MMS pain classification, and more medication use after GKS (p < 0.05). Conversely, increase in numbness intensity after GKS was associated with a decrease in pain intensity and pain length (p < 0.05). Conclusions Gamma Knife surgery using a maximum dose of 90 Gy to the trigeminal nerve provides satisfactory long-term pain control, reduces the use of medication, and improves quality of life. Physicians must be aware that higher doses may be associated with an increase in bothersome sensory complications. The benefits and risks of higher dose selection must be carefully discussed with patients, since facial numbness, even if bothersome, may be an acceptable trade-off for patients with severe pain.

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Section: Dose Selection and Trigeminal Neuropathymentioning

confidence: 99%

Long-term outcome of high-dose Gamma Knife surgery in treatment of trigeminal neuralgia

Young¹,

Shivazad

Kryscio

et al. 2013

JNS

View full text Add to dashboard Cite

show abstract

“…It seems that age is not a prognostic factor with "reasonable agreement". In spite of female gender seems to be slightly more frequent in the series (Brisman , 2004;Longhi , 2007;Pollock, 2002;), concerning pain outcome it has been systematically communicated that this variable has not prognostic significance (Aubuchon, 2010;Azar, 2009;Brisman , 2004;Dellaretti, 2008;;Hayashi, 2009;Kimball, 2010;Longhi, 2007;Massager 2007aPark, 2011Riesenburger, 2010;;Rogers, 2000;Sheehan, 2005;Tawk, 2005;Young, 1998): There was found "Consistent agreement" indicating that gender is not a prognostic variable for pain control.…”

Section: Clinical Variablesmentioning

confidence: 82%

“…Right side seems to be slightly more frequent (Aubuchon, 2010;Cheuk, 2004;Dhople, 2009;Huang, 2008;Kimball, 2010;Pan, 2010;Park, 2011;Regís, 2006;Shaya, 2004;Tawk, 2005), Most authors coincide that the side of the neuralgia has not a prognostic factor (Brisman, 2004;Hayashi, 2009;Kimball, 2010;Little, 2008;Massager , 2007a;;Park, 2011;Riesenburger, 2010;Tawk, 2005). Sheehan (Sheehan, 2005) on the other hand, found better results in patients with right side neuralgia.…”

Section: Sidementioning

confidence: 95%

“…Han (Han, 2009), Sheehan (Sheehan, 2005), Regis (Regís, 2006) and Towk (Tawk, 2005) conversely described worse results in younger patients. In spite of these controversial results, the majority of authors have not found significant influence of the patient age in pain control (Aubuchon, 2010;Azar, 2009;Brisman, 2004;Dellaretti, 2008;Hayashi, 2009;Little, 2008;Longhi, 2007;Massager, 2007a;Park, 2011;Petit, 2003;Riesenburger, 2010;Rogers, 2000;Young, 1998). It seems that age is not a prognostic factor with "reasonable agreement".…”

Section: Clinical Variablesmentioning

confidence: 97%

“…If the analysis is done in those series that compare classic trigeminal neuralgia and neuralgia associated to multiple sclerosis, some authors reported worse results in cases of multiple sclerosis (Brisman 2000a;Cheng, 2005;Morbidini-gaffney, 2006;Verheul, 2010;Young, 1998). Other manuscripts did not report significant differences in pain control between classic trigeminal neuralgia and neuralgia secondary to multiple sclerosis (Cheuk, 2004;Petit, 2003;Regís, 2009;Riesenburger, 2010;;Rogers, 2000). No communication exists informing better results when multiple sclerosis is present.…”

Section: Association With Multiple Sclerosismentioning

confidence: 99%

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