The Very Long-Term Outcome of Radiosurgery for Classical Trigeminal Neuralgia

Abstract

Background: Radiosurgery is one of the neurosurgical alternatives for intractable trigeminal neuralgia (TN). Objective: Although acceptable short-/mid-term outcomes have been reported, long-term results have not been well documented. Methods: We report the long-term results in 130 patients who underwent radiosurgery for classical TN and were subsequently monitored through at least 7 years (median = 9.9, range = 7-14.5) of follow-up. Results: The median age was 66.5 years. A total of 122 patients (93.8%) became pain free (median delay = 15 days) after the radiosurgery procedure (Barrow Neurological Institute, BNI class I-IIIa). The probability of remaining pain free without medication at 3, 5, 7 and 10 years was 77.9, 73.8, 68 and 51.5%, respectively. Fifty-six patients (45.9%) who were initially pain free experienced recurrent pain (median delay = 73.1 months). However, at 10 years, of the initial 130 patients, 67.7% were free of any recurrence requiring new surgery (BNI class I-IIIa). The new hypesthesia rate was 20.8% (median delay of onset = 12 months), and only 1 patient (0.8%) reported very bothersome hypesthesia. Conclusions: The long-term results were comparable to those from our general series (recently published), and the high probability of long-lasting pain relief and rarity of consequential complications of radiosurgery may suggest it as a first- and/or second-line treatment for classical, drug-resistant TN.

Stereotactic radiosurgery for trigeminal neuralgia: a systematic review

“…With the exception of 1 prospective study by Régis et al, 112 all other studies were retrospective. In addition to those studies selected for the systematic review, we separately discuss trials that considered MVD versus RS (4 studies); 73,92,94,107 eye lens dose (2); 70,81 CT only-based targeting (4); 7,71,96,140 anterior versus REZ target (3); 88,99,141 the relationship between focal enhancement of the trigeminal nerve and/or brainstem and outcome (3); 2,38,40 one versus two 4-mm isocenters (4); 4,26,32,106 one 4-mm isocenter versus concentric 4-and 8-mm isocenters (1); 54 the neurovascular conflict and its effect on pain relief (5); 14,30,85,120,122 major neurovascular conflict by the megadolichobasilar artery (3); 97,127,135 eventual vascular damage after RS (1); 78 QOL and patient satisfaction (6); 9,51,95,103,112,115 potential impact of radiation dose rate (3); 6,10,68 eventual radioprotective effects of medication (1); 33 effect of beam channel blocking, with a longer irradiated nerve and integral dose (2); 86,87 timing of RS from the onset of symptoms (1); 91 previous surgery versus no previous surgery (2); 34,35 GKS after previous surgery (3); 49,…”

“…The anterior cisternal target has been used by Rand et al, 109 Régis et al, 112,114,115,134 Dellaretti et al, 24 Lucas et al, 80 and Massager et al 85 Otherwise, the REZ has been the most consistent target ( Table 1 and Fig. 2).…”

“…2). 109,115 Lindquist subsequently promoted the elegant idea of targeting the REZ (also referred to as the "dorsal REZ" in the literature) where the nerve exits the brainstem with a lower dose of 70 Gy. 3 Kondziolka et al 63 and Régis et al 114 reported the results for FFP without medication at 10 years after targeting the REZ and the anterior cisternal target, respectively.…”

“…Several large Gamma Knife surgery (GKS) series have already advocated for the safety and efficacy of RS, in particular, by reporting longterm and very-long-term results. 63,110,114,115,144 Additionally, a small number of studies have reported outcomes for the other RS techniques, including the LINAC and CKR, though with a more limited number of patients and followup periods. 1,12,31,102,119,124,125,129,138 The aims of this systematic review are to provide an objective summary of the published literature specific to the treatment of TN with RS and to develop consensus guideline recommendations for the use of RS, as endorsed by the International Society of Stereotactic Radiosurgery (ISRS).…”

Stereotactic Radiosurgery as Initial Surgical Management for Elderly Patients with Trigeminal Neuralgia

“…The rate for new hypethesia following repeat SRS was 33%. In a recent study, Régis et al [23] evaluated the long-term outcome of gamma knife radiosurgery in 130 patients with classical TN. The probability of remaining pain-free without medication at 5, 7, and 10 years after radiosurgery was 73.8, 68, and 51.5%, respectively.…”