The role of radiosurgery in trigeminal neuralgia

Fariselli, Laura; Ghielmetti, F.; Bosetti, D.; Franzini, Angelo; Marchetti, M.

doi:10.1007/s10072-017-2892-y

Cited by 8 publications

(5 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Stereotactic radiosurgery (SRS) plays an important role in multimodal neuro-oncological treatment of a broad spectrum of intracranial diseases. Additionally, the technique has been introduced as treatment option in trigeminal neuralgia [1], in case of inoperable arteriovenous malformations [2] and has also been used in the treatment of refractory epilepsy [3]. SRS is widely used for the treatment of metastases [4], meningiomas [5] and vestibular schwannomas (VS) [6,7] where long-term local tumor control can be achieved in VS and meningioma [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Radiation Necrosis in Patients Undergoing Cranial Stereotactic Radiosurgery

Kerschbaumer

Demetz

Krigers

et al. 2021

Cancers

View full text Add to dashboard Cite

Purpose: single-staged stereotactic radiosurgery (SRS) is an established part of the multimodal treatment in neuro-oncology. Radiation necrosis after high-dose irradiation is a known complication, but there is a lack of evidence about the risk factors. The aim of this study was to evaluate possible risk factors for radiation necrosis in patients undergoing radiosurgery. Methods: patients treated with radiosurgery between January 2004 and November 2020 were retrospectively analyzed. The clinical data, imaging and medication were gathered from electronic patient records. The largest diameter of the tumors was measured using MRI scans in T1 weighted imaging with gadolinium and the edema in T2 weighted sequences. The diagnosis of a radiation necrosis was established analyzing imaging criteria combined with clinical course or pathologically confirmed by subsequent surgical intervention. Patients developing radiation necrosis detected after SRS were compared to patients without evidence of an overshooting irradiation reaction. Results: 388 patients were included retrospectively, 61 (15.7%) of whom developed a radiation necrosis. Median follow-up was 24 (6–62) months with a radiation necrosis after 8 (6–12) months. The most frequent tumors were metastases in 47.2% of the cases, followed by acoustic neuromas in 32.2% and meningiomas in 13.4%. Seventy-three (18.9%) patients already underwent one or more previous radiosurgical procedures for different lesions. The mean largest diameter of the tumors amounted to 16.3 mm (± 6.1 mm). The median—80%—isodose administered was 16 (14–25) Gy. Of the radiation necroses, 25 (43.1%) required treatment, in 23 (39.7%) thereof, medical treatment was applied and in 2 (3.4%) cases, debulking surgery was performed. In this study, significantly more radiation necroses arose in patients with higher doses (HR 1.3 [CI 1.2; 1.5], p < 0.001) leading to a risk increment of over 180% between a radiation isodose of 14 and 20 Gy. The maximum diameter was a second significant risk factor (p = 0.028) with an HR of 1065 for every 1 mm increase in multivariate analysis. Conclusion: large diameter and high doses were reliable independent risk factors leading to more frequent radiation necroses, regardless of tumor type in patients undergoing radiosurgery. Alternative therapeutic procedures may be considered in lesions with large volume and an expected high radiation doses due to the increased risk of developing radiation necrosis.

show abstract

Section: Introductionmentioning

confidence: 99%

Risk Factors for Radiation Necrosis in Patients Undergoing Cranial Stereotactic Radiosurgery

Kerschbaumer

Demetz

Krigers

et al. 2021

Cancers

View full text Add to dashboard Cite

show abstract

“…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][8][9][10][11], but few studies [12][13][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: 98%

“…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%

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

“…A prospective, non-randomized study shows that retrogasserian glycerol injection and RFT can induce a moderate reduction in pain in refractory trigeminal neuralgia [ 166 ]. Finally, Gamma Knife radiosurgery may be considered as first line approach in aged patients, in patients with multiple sclerosis or in case of MVD inefficacy [ 167 ].…”

Section: Q5 – What Is the Evidence For Using Pharmacological And Non-mentioning

confidence: 99%

Assessing and treating primary headaches and cranio-facial pain in patients undergoing rehabilitation for neurological diseases

et al. 2017

View full text Add to dashboard Cite

BackgroundPain is a very common condition in patient undergoing rehabilitation for neurological disease; however the presence of primary headaches and other cranio-facial pains, particularly when they are actually or apparently independent from the disability for which patient is undergoing rehabilitation, is often neglected. Diagnostic and therapeutic international and national guidelines, as well as tools for the subjective measure of head pain are available and should also be applied in the neurorehabilitation setting. This calls for searching the presence of head pain, independently from the rehabilitation needs, since pain, either episodic or chronic, interferes with patient performance by affecting physical and emotional status. Pain may also interfere with sleep and therefore hamper recovery.MethodsIn our role of task force of the Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN), we have elaborated specific recommendations for diagnosing and treating head pains in patients undergoing rehabilitation for neurological diseases.Results and ConclusionIn this narrative review, we describe the available literature that has been evaluated in order to define the recommendations and outline the needs of epidemiological studies concerning headache and other cranio-facial pain in neurorehabilitation.

show abstract

The role of radiosurgery in trigeminal neuralgia

Abstract: A short review of clinical use of radiosurgery in trigeminal neuralgia is offered.

Cited by 8 publications

References 15 publications

Risk Factors for Radiation Necrosis in Patients Undergoing Cranial Stereotactic Radiosurgery

Risk Factors for Radiation Necrosis in Patients Undergoing Cranial Stereotactic Radiosurgery

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

Assessing and treating primary headaches and cranio-facial pain in patients undergoing rehabilitation for neurological diseases

Contact Info

Product

Resources

About