Repeat Gamma Knife Radiosurgery for Trigeminal Neuralgia

Park, Kyung-Jae; Kondziolka, Douglas; Berkowitz, Oren; Kano, Hideyuki; Novotný, Josef; Niranjan, Ajay; Flickinger, John C.; Lunsford, L. Dade

doi:10.1227/neu.0b013e318230218e

Cited by 63 publications

(82 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1,9,13,16,18,19,24,34,36,45 Yet 25% of patients experienced recurrent pain (BNI Score IV or V) at a median of 17 months following a repeat GKRS. 26,34 We hypothesized that there exists a subset of patients who may benefit from a third radiosurgical procedure, predicted by their prior favorable response to GKRS. TN is frequent in the elderly population; many of these patients are on a regimen of anticoagulation and/or antiplatelet therapy that poses bleeding risks to invasive microsurgical or percutaneous procedures.…”

Section: Discussionmentioning

confidence: 99%

“…34 One patient had Type II pain, described as mostly constant, aching or stabbing pain. 43 Three patients had Type I pain suspected to be related to vascular compression as seen on brain imaging.…”

Section: Patient Selectionmentioning

confidence: 99%

“…The radiosurgical procedure has been previously described. 21,34 After application of a Leksell stereotactic frame (Elekta Instruments) under local anesthesia and intravenous conscious sedation, all patients underwent stereotactic MRI to identify the trigeminal nerve. MRI was performed by the use of contrast-enhanced, short repetition time sequences, and axial volume acquisitions divided into 1-mm slices.…”

Section: Radiosurgical Proceduresmentioning

confidence: 99%

“…29,48 Rates of initial pain relief reported in the literature for single repeat GKRS in TN patients are similar. 1,9,13,16,18,19,24,34,36,45 In a large recent series, Park et al described their experience with repeat GKRS for recurrent TN in 119 patients at a median of 26 months after primary GKRS and noted that 87% of patients achieved initial pain relief (BNI Scores I-IIIb), 88% of whom maintained relief at 1 year, and 70% of whom maintained relief at 3 years after repeat GKRS. 34 Aubuchon et al and…”

Section: Repeat Gkrs For Tnmentioning

confidence: 99%

“…15,27,46 Such patients have been found to benefit from repeat GKRS, with success rates of between 62% and 95% at a median 32-month follow-up. 1,9,13,16,18,19,24,34,36,45 In this report, we describe our experience in a small cohort of patients who ultimately underwent 3 GKRS procedures because of the recurrence of medically intractable pain. We analyze the outcomes in such patients, including the extent and duration of pain relief.…”

mentioning

confidence: 99%

See 4 more Smart Citations

The results of a third Gamma Knife procedure for recurrent trigeminal neuralgia

Tempel

Chivukula

Monaco

et al. 2015

JNS

Self Cite

View full text Add to dashboard Cite

OBJECT Gamma Knife radiosurgery (GKRS) is the least invasive treatment option for medically refractory, intractable trigeminal neuralgia (TN) and is especially valuable for treating elderly, infirm patients or those on anticoagulation therapy. The authors reviewed pain outcomes and complications in TN patients who required 3 radiosurgical procedures for recurrent or persistent pain. METHODS A retrospective review of all patients who underwent 3 GKRS procedures for TN at 4 participating centers of the North American Gamma Knife Consortium from 1995 to 2012 was performed. The Barrow Neurological Institute (BNI) pain score was used to evaluate pain outcomes. RESULTS Seventeen patients were identified; 7 were male and 10 were female. The mean age at the time of last GKRS was 79.6 years (range 51.2–95.6 years). The TN was Type I in 16 patients and Type II in 1 patient. No patient suffered from multiple sclerosis. Eight patients (47.1%) reported initial complete pain relief (BNI Score I) following their third GKRS and 8 others (47.1%) experienced at least partial relief (BNI Scores II–IIIb). The average time to initial response was 2.9 months following the third GKRS. Although 3 patients (17.6%) developed new facial sensory dysfunction following primary GKRS and 2 patients (11.8%) experienced new or worsening sensory disturbance following the second GKRS, no patient sustained additional sensory disturbances after the third procedure. At a mean follow-up of 22.9 months following the third GKRS, 6 patients (35.3%) reported continued Score I complete pain relief, while 7 others (41.2%) reported pain improvement (BNI Scores II–IIIb). Four patients (23.5%) suffered recurrent TN following the third procedure at a mean interval of 19.1 months. CONCLUSIONS A third GKRS resulted in pain reduction with a low risk of additional complications in most patients with medically refractory and recurrent, intractable TN. In patients unsuitable for other microsurgical or percutaneous strategies, especially those receiving long-term oral anticoagulation or antiplatelet agents, GKRS repeated for a third time was a satisfactory, low risk option.

show abstract