The retrogasserian zone versus dorsal root entry zone: comparison of two targeting techniques of gamma knife radiosurgery for trigeminal neuralgia

Park, Seong‐Hyun; Hwang, Sung-Kyoo; Kang, Donghoon; Park, Jaechan; Hwang, Jeong-In; Sung, Joo-Kyung

doi:10.1007/s00701-010-0610-0

Cited by 46 publications

(35 citation statements)

References 15 publications

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“…Park and colleagues presented a study directly comparing 2 targeting locations in a total of 39 patients who underwent SRS with a mean follow-up of 32.8 months in the DREZ group and 16.5 months in the retrogasserian zone (RGZ) group. 15 A maximum dose with a range of 80-90 Gy was used for DREZ targeting and a range of 83 Gy to 90 Gy for RGZ targeting. The study identified no difference in the risk of postradiosurgical complications, but the authors did find a shorter response time in the RGZ group (4.1 weeks vs 6.4 weeks, p = 0.044).…”

Section: Discussionmentioning

confidence: 99%

Impact of target location on the response of trigeminal neuralgia to stereotactic radiosurgery

Xu¹,

Schlesinger

Moldovan³

et al. 2014

JNS

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Object The authors evaluate the impact of target location on the rate of pain relief (PR) in patients with intractable trigeminal neuralgia (TN) undergoing stereotactic radiosurgery (SRS). Methods The authors conducted a retrospective review of 99 patients with idiopathic TN who were identified from a prospectively maintained database and were treated with SRS targeting the dorsal root entry zone with a maximum dose of 80 Gy. Targeting of the more proximal portion of a trigeminal nerve with the 50% isodose line overlapping the brainstem was performed in 36 patients (proximal group). In a matched group, 63 patients received SRS targeting the 20% isodose line tangential to the emergence of the brainstem (distal group). The median follow-up time was 33 months (range 6–124 months). Results The actuarial rate of maintenance of Barrow Neurological Institute (BNI) Pain Score I–IIIa was attained in 89% of patients at 1 year, 81% at 2 years, and 69% at 4 years, respectively, after SRS. Kaplan-Meier analysis revealed that durability of PR was only associated with the proximal location of the radiosurgical target (log-rank test, p = 0.018). Radiosurgery-induced facial numbness (BNI Score II or III) developed in 35 patients, which was significantly more frequent in the proximal group (19 patients [53%] compared with 16 [25%] in the distal group [p = 0.015]). Conclusions The radiosurgical target appears to affect the duration of pain relief in patients with idiopathic trigeminal neuralgia with the target closer to the brainstem affording extended pain relief. However, the proximal SRS target was also associated with an increased risk of mild to moderate facial numbness.

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Section: Discussionmentioning

confidence: 99%

Impact of target location on the response of trigeminal neuralgia to stereotactic radiosurgery

Xu¹,

Schlesinger

Moldovan³

et al. 2014

JNS

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“…It has been taking advantage in the pain relief for the stereotactic radiosurgery to treat primary trigeminal neuralgia, which has high efficacy rate (88-96%), good quality life rate (about 85%) and low complication and recurrence rate (4-12%) (10,17). Compared with the classic vascular decompression of the trigeminal nerve, it was satisfied from less complication, efficiency rate and patients' satisfaction (7,11).…”

Section: Discussionmentioning

confidence: 99%

Effect of the gamma knife treatment on the trigeminal nerve root in chinese patients with primary trigeminal neuralgia

Song

Qian²,

Wu³

et al. 2013

Turkish Neurosurgery

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AIm:To understand the mechanism of the gamma knife treating the trigeminal neuralgia. mATeRIAL and meTHods: Using the MASEP-SRRS type gamma knife treatment system, 140 Chinese patients with trigeminal neuralgia (NT) were treated in our hospital from 2002 to 2010, in which the pain relief rate reached 95% and recurrence rate was 3% only. We investigated the effect of the gamma knife treatment on the trigeminal nerve root in 20 Chinese patients with primary trigeminal neuralgia by the magnetic resonance imager (MRI) observation.ResuLTs: 1) The cross-sectional area of trigeminal nerve root became smaller and MRI signals were lower in the treatment side than those in the non-treatment side after the gamma knife treatment of primary trigeminal neuralgia; 2) in the treatment side, the cross-sectional area of the trigeminal nerve root decreased significantly after the gamma knife treatment; 3) there was good correlation between the clinical improvement and the MRI findings; and 4) the straight distance between the trigeminal nerve root and the brainstem did not change after the gamma knife treatment. CoNCLusIoN:The pain relief induced the gamma knife radiosurgery might be related with the atrophy of the trigeminal nerve root in Chinese patients with primary trigeminal neuralgia. BuLGuLAR: 1) Trigeminal sinir kökünün çapraz kesit alanı primer trigeminal nevraljinin gamma bıçağı tedavisinden sonra tedavi tarafında tedavi edilmemiş tarafa göre daha küçük ve MRG sinyalleri daha düşüktü; 2) tedavi tarafında trigeminal sinir kökünün çapraz kesit alanı gamma bıçağı tedavisinden sonra önemli ölçüde azaldı; 3) klinik iyileşme ve MRG bulguları arasında iyi korelasyon vardı; ve 4) trigeminal sinir kökü ile beyin kökü arasındaki düz mesafe gamma bıçağı tedavisi sonrasında değişmedi. soNuÇ: Gamma bıçağı radyocerrahisinin oluşturduğu ağrı giderme primer trigeminal nevraljili Çinli hastalarda trigeminal sinir kökünün atrofisiyle ilişkili olabilir.ANAHTAR sÖZCÜKLeR: Gamma bıçağı, Trigeminal sinir kökü, Primer trigeminal nevralji, MRG

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“…Matsuda (Matsuda 2008) in a series of 100 patients reports better pain control and lesser morbidity in patients treated with a proximal compared with those treated with a distal target. Conversely, Park (Park 2010) in a series of 39 patients found that a distal target was associated to more rapid response, better pain control and lower nerve morbidity. With the data available in the literature there are not clear differences in terms of clinical results between the two targets, then, considering any of these two targets as prognostic variable "scarce information with no clear trend or controversial findings" exist.…”

Section: Proximal Nerve Targetingmentioning

confidence: 94%

Clinical, Anatomo-Radiological and Dosimetric Features Influencing Pain Outcome After Gamma Knife Treatment of Trigeminal Neuralgia

Lorenzoni¹,

Zarate²,

Ramón³

et al. 2011

Gamma Knife Radiosurgery

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The retrogasserian zone versus dorsal root entry zone: comparison of two targeting techniques of gamma knife radiosurgery for trigeminal neuralgia

Abstract: The RGZ targeting technique in the GKRS for TN had a better treatment success, with fewer bothersome complications compared to the DREZ target.

Cited by 46 publications

References 15 publications

Impact of target location on the response of trigeminal neuralgia to stereotactic radiosurgery

Impact of target location on the response of trigeminal neuralgia to stereotactic radiosurgery

Effect of the gamma knife treatment on the trigeminal nerve root in chinese patients with primary trigeminal neuralgia

Clinical, Anatomo-Radiological and Dosimetric Features Influencing Pain Outcome After Gamma Knife Treatment of Trigeminal Neuralgia

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