Prospective controlled trial of gamma knife surgery for essential trigeminal neuralgia

Régis, Jean; Métellus, Philippe; Hayashi, Motohiro; Roussel, Philippe; Donnet, Anne; Billé-Turc, F

doi:10.3171/jns.2006.104.6.913

Cited by 240 publications

(187 citation statements)

References 69 publications

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“…16 Later, Leksell conceived the Gamma Knife, a tool dedicated to radiosurgery that uses multiple focusing beams from cobalt-60 sources. 15 Several retrospective studies 6,13 and a few prospective studies 32 have reported good short-term and midterm safety and efficacy of Gamma Knife surgery (GKS) for TN. GKS is known to be the least invasive neurosurgical approach for medically refractory TN.…”

mentioning

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

Self Cite

139

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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mentioning

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

Self Cite

139

126

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“…Extensive wordwide research has been conducted regarding underlying pathophysiological mechanisms of pain relief, 26 clinical outcomes, 5,27,28,32,55,58,63 and comparative technologies. 37 Because of the nonexistent procedure-related mortality rate, the low risk of significant complications, and its ability to provide pain control for tic doloreux, SRS for TN has certainly become one of the most important options when recommending treatment modalities to patients.…”

Section: Trigeminal Neuralgia and Other Neuralgiasmentioning

confidence: 99%

“…In another prospective study 55 radiosurgical treatment of the TREZ using 70-90 Gy, 83 of 100 patients were pain free either with or without medication. A quality-of-life assessment in these patients indicated a statistically significant improvement in all tested areas.…”

Section: Neurosurg Focus / Volume 23 / December 2007mentioning

confidence: 99%

Stereotactic radiosurgery for functional disorders

Friehs

Park

Goldman

et al. 2007

FOC

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✓ Stereotactic radiosurgery (SRS) with the Gamma Knife and linear accelerator has revolutionized neurosurgery over the past 20 years. The most common indications for radiosurgery today are tumors and arteriovenous malformations of the brain. Functional indications such as treatment of movement disorders or intractable pain only contribute a small percentage of treated patients. Although SRS is the only noninvasive form of treatment for functional disorders, it also has some limitations: neurophysiological confirmation of the target structure is not possible, and one therefore must rely exclusively on anatomical targeting. Furthermore, lesion sizes may vary, and shielding adjacent radiosensitive neural structures may be difficult or impossible. The most common indication for functional SRS is the treatment of trigeminal neuralgia. Radiosurgical treatment for epilepsy and certain psychiatric illnesses is performed in several centers as part of strict research protocols, and radiosurgical pallidotomy or medial thalamotomy is no longer recommended due to the high risk of complications. Radiosurgical ventrolateral thalamotomy for the treatment of tremor in patients with Parkinson disease or multiple sclerosis, as well as in the treatment of essential tremor, may be indicated for a select group of patients with advanced age, significant medical conditions that preclude treatment with open surgery, or patients who must receive anticoagulation therapy. A promising new application of SRS is high-dose radiosurgery delivered to the pituitary stalk. This treatment has already been successfully performed in several centers around the world to treat severe pain in patients with end-stage cancer.

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“…Hypoesthesia as a side-effect is reported at 0% to 54% according to the series [20]. Analysis of the literature shows that obtention of pain relief and its duration are dependent on irradiation intensity; 90 Gy is the value commonly assumed to be effective [16,18,21]. It has also been noted that the degree of hypoesthesia is proportional to intensity.…”

Section: The Neurosurgical Armamentariummentioning

confidence: 99%

Trigeminal neuralgia: a plea for microvascular decompression as the first surgical option. Anatomy should prevail

Sindou

2009

Acta Neurochir

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Prospective controlled trial of gamma knife surgery for essential trigeminal neuralgia

Abstract: Radiosurgery is a safe and effective alternative treatment for trigeminal neuralgia and is associated with a particularly low rate of hypesthesia.

Cited by 240 publications

References 69 publications

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

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

Stereotactic radiosurgery for functional disorders

Trigeminal neuralgia: a plea for microvascular decompression as the first surgical option. Anatomy should prevail

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