Stereotactic radiosurgery in treatment of trigeminal neuralgia

Bervitskiy, Anatoliy V.; Мойсак, Галина Ивановна; Zubatkina, I.; Ivanov, Pavel; Рзаев, Д. А.; Амелина, Е. Л.

doi:10.17116/neiro20198302137

Cited by 1 publication

(3 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Gamma knife radiosurgery (GKRS) has been proposed as an effective treatment option for patients with drug-resistant TN. Numerous studies have been published demonstrating SRS effectiveness towards reducing trigeminal pain, including the present study [ 4 , 7 - 11 ], but few studies [ 12 - 14 ] compare the two major targeting methods (i.e., RGZ and DREZ) for which, despite being highly known, the optimal targeting zones remain controversial.…”

Section: Discussionmentioning

confidence: 99%

“…Surgically separating existing neurovascular conflict is currently considered the “gold standard” for patients not responding to pharmacological treatment, but not all patients are suitable candidates for surgical treatment. Therefore, less invasive procedures, such as stereotactic radiosurgery (SRS), become an alternative [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have reinforced the safety and efficacy of SRS as a treatment option for TN [4,[7][8][9][10][11], and although two target zones are usually described and compared -dorsal root entry zone (DREZ) and retrogasserian zone (RGZ) -the optimal targeting technique remains controversial, and few published studies compare such targeting methods and their outcomes [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Gamma Ray Radiosurgery for Trigeminal Neuralgia: Targeting Proximal or Distal to the Dorsal Root Entry Zone

Lovo¹,

Moreira²,

Barahona³

et al. 2021

Cureus

View full text Add to dashboard Cite

Introduction Stereotactic radiosurgery for trigeminal neuralgia (TN) has gained interest among patients who are not suitable for surgical procedures. Although two target zones are more recognized - dorsal root entry zone (DREZ) and retrogasserian zone (RGZ) - the optimal targeting technique remains controversial in terms of clinical outcomes and rates of complications. Therefore, various modifications to the radiosurgical technique for TN have been made. Objective This study aimed to determine the differences in shoot location (i.e., RGZ vs. DREZ) regarding effectiveness and adverse effects in patients with medically refractory TN. Additionally, we evaluated the effect of the integral dose (ID) on treatment outcomes and complications. Methods We present a retrospective cohort study of 49 patients with primary, drug-resistant TN treated with gamma knife radiosurgery targeting the distal and proximal parts of the nerve regarding the DREZ with a prescription dose of 90 Gy (80 to 96 Gy). A subset of these patients (n=38) where the ID could be measured to the nerve was correlated to treatment outcomes and complications. Results The median follow-up time was 36 months for RGZ and 51 months for DREZ targets. Neurovascular conflict was identified in 87.5% of the RGZ group and 88.2% of the DREZ group. Using the Barrow Neurological Institute (BNI) pain score, 26 (81.3%) RGZ and 12 (70.6%) DREZ patients were successfully treated (BNI I-IIIb; p=0.02). Seven (21.9%) RGZ and eight (47.1%) DREZ patients reported complete pain relief without medication (BNI I). Time response was 22.3 days for RGZ and 34.1 days for DREZ (p=0.277). There were 10 (31.3%) patients in the RGZ group with associated complications versus six (35.3%) patients in the DREZ group (χ 2 =0.0826, degree of freedom=1, p=0.773). Treatment outcomes using higher ID were better in the RGZ than DREZ (81.8% vs. 57.1, respectively), and a significant association was found between a higher ID delivered to the nerve and the development of complications (p=0.02). Conclusion Based on the obtained results, the RGZ was a more effective targeting area with better treatment outcomes without significant differences in complication rates than DREZ. A higher ID at the RGZ than DREZ had a greater therapeutical effect. Further investigation regarding the optimal target area along the ID delivered and clinical outcomes are required.

show abstract