Salvage Gamma Knife Stereotactic Radiosurgery for Surgically Refractory Trigeminal Neuralgia

Little, Andrew S.; Shetter, Andrew G.; Shetter, Mary E.; Kakarla, U Kumar; Rogers, C. Leland

doi:10.1016/j.ijrobp.2008.08.048

Cited by 36 publications

(17 citation statements)

References 30 publications

(41 reference statements)

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“…Little et al 38 stated that it "seems not to be necessary to decrease the doses in patients with prior trigeminal dysfunction" and also that there is more Level III evidence for ranges of doses between 40 and 70 Gy. Hasega-wa et al 22 compared combined high doses (140-160 Gy) versus lower doses (120-135 Gy) and concluded that there was no difference in recurrence rates but that there was increased hypesthesia with the higher doses (32% vs 4%).…”

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

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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.

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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

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“…Little et al 28 reported the use of GKSR for TN that recurred after surgery. Complete pain relief (BNI grade I) was observed in 20% of patients, and partial pain relief (BNI grade II-IIIb) was achieved in 30% of patients at 5 years.…”

Section: Percutaneous Proceduresmentioning

confidence: 99%

Outcome Predictors After Gamma Knife Radiosurgery for Recurrent Trigeminal Neuralgia

et al. 2010

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“…S et al suggested that unlike other invasive procedures, the strongest predictor of GKRS failure was a history of prior MVD. [27] This implies prior invasive treatments may be more different from each other than we think and these treatments cannot be analyzed as a single factor. In addition, the type of pain that patients suffered from in our study was not identical.…”

Section: Discussionmentioning

confidence: 95%

Effect of radiation dose on the outcomes of gamma knife treatment for trigeminal neuralgia: A multi-factor analysis

Zhang

et al. 2014

Neurol India

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Our limited results suggested that a higher integrated dose might increase the incidence of trigeminal nerve toxicity with no significant benefits in pain relief when the maximal doses were within 75-90 Gy. The protocol for increasing radiation variables such as longer nerve exposure length and higher maximal dose is not recommended as a routine approach and more randomized studies with large number of cases would be required to verify the best treatment strategy of gamma knife radiosurgery for TN.

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Salvage Gamma Knife Stereotactic Radiosurgery for Surgically Refractory Trigeminal Neuralgia

Cited by 36 publications

References 30 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

Outcome Predictors After Gamma Knife Radiosurgery for Recurrent Trigeminal Neuralgia

Effect of radiation dose on the outcomes of gamma knife treatment for trigeminal neuralgia: A multi-factor analysis

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