Trigeminal neuralgia treatment outcomes following Gamma Knife radiosurgery with a minimum 3-year follow-up

Karam, Sana D.; Tai, Alexander; Wooster, Margaux; Rashid, Abdul; Chen, Rosanna; Baig, Nimrah; Jay, Ann K.; Harter, K. William; Randolph-Jackson, Pamela; Omogbehin, Adedamola; Aulisi, Edward F.; Jacobson, Jeff

doi:10.1007/s13566-013-0134-3

Cited by 26 publications

(13 citation statements)

References 21 publications

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“…14,16,21 We did not find an association of pain response with development of new numbness or hypesthesia. In addition, we found that younger age, not older age, 7 was associated with recurrence of pain, but this may reflect lack of long term follow-up, and we will have to continue to study longer term outcomes to confirm this findings. In addition, we did not review location of the GKRS isocenter as a predictor of outcome.…”

Section: Discussionmentioning

confidence: 89%

Higher dose rate Gamma Knife radiosurgery may provide earlier and longer-lasting pain relief for patients with trigeminal neuralgia

Lee¹,

Sandhu²,

Miller³

et al. 2015

JNS

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Prior studies investigating the role of dose rate in Gamma Knife radiosurgical ablation for TN have not used validated outcome tools to measure pain preoperatively. Consequently, differences in pain outcomes have been difficult to measure. By administering pain scales both preoperatively as well as postoperatively, the authors have identified statistically significant differences in pain intensity and pain interference with activities of daily living when comparing higher versus lower dose rates. Radiosurgery with a higher dose rate results in more pain relief at the early follow-up evaluation, and it may result in a lower recurrence rate at later follow-up.

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Section: Discussionmentioning

confidence: 89%

Higher dose rate Gamma Knife radiosurgery may provide earlier and longer-lasting pain relief for patients with trigeminal neuralgia

Lee¹,

Sandhu²,

Miller³

et al. 2015

JNS

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“…Positive predictors before RS are an increased age, 83,121 age more than 70 years, 43,57 and typical pain. 77 Negative predictors before RS include multiple sclerosis, 13,62,76,90,112,137 prior surgery 57,74,82,103,106,132 or ablative procedures, 86,132 an atypical component, 82,118 appearance or aggravation of a sensory deficit, 82 previous MVD, 66,75,120,133 age under 70 years, 132 age under 60 years, 112 distance between the isocenter and the exit of the nerve > 8 mm, 112 and diabetes mellitus. 83 Later pain relief maintenance following RS has been positively associated with new facial numbness 63,106,118,132 and no past surgery 25 and negatively associated with a better initial response.…”

Section: General Aspectsmentioning

confidence: 99%

Stereotactic radiosurgery for trigeminal neuralgia: a systematic review

Tuleasca

Régis

Sahgal

et al. 2019

Journal of Neurosurgery

133

124

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OBJECTIVES The aims of this systematic review are to provide an objective summary of the published literature specific to the treatment of classical trigeminal neuralgia with stereotactic radiosurgery (RS) and to develop consensus guideline recommendations for the use of RS, as endorsed by the International Society of Stereotactic Radiosurgery (ISRS). METHODS The authors performed a systematic review of the English-language literature from 1951 up to December 2015 using the Embase, PubMed, and MEDLINE databases. The following MeSH terms were used in a title and abstract screening: "radiosurgery" AND "trigeminal." Of the 585 initial results obtained, the authors performed a full text screening of 185 studies and ultimately found 65 eligible studies. Guideline recommendations were based on level of evidence and level of consensus, the latter predefined as at least 85% agreement among the ISRS guideline committee members. RESULTS The results for 65 studies (6461 patients) are reported: 45 Gamma Knife RS (GKS) studies (5687 patients [88%]), 11 linear accelerator (LINAC) RS studies (511 patients [8%]), and 9 CyberKnife RS (CKR) studies (263 patients [4%]). With the exception of one prospective study, all studies were retrospective. The mean maximal doses were 71.1-90.1 Gy (prescribed at the 100% isodose line) for GKS, 83.3 Gy for LINAC, and 64.3-80.5 Gy for CKR (the latter two prescribed at the 80% or 90% isodose lines, respectively). The ranges of maximal doses were as follows: 60-97 Gy for GKS, 50-90 Gy for LINAC, and 66-90 Gy for CKR. Actuarial initial freedom from pain (FFP) without medication ranged from 28.6% to 100% (mean 53.1%, median 52.1%) for GKS, from 17.3% to 76% (mean 49.3%, median 43.2%) for LINAC, and from 40% to 72% (mean 56.3%, median 58%) for CKR. Specific to hypesthesia, the crude rates (all Barrow Neurological Institute Pain Intensity Scale scores included) ranged from 0% to 68.8% (mean 21.7%, median 19%) for GKS, from 11.4% to 49.7% (mean 27.6%, median 28.5%) for LINAC, and from 11.8% to 51.2% (mean 29.1%, median 18.7%) for CKR. Other complications included dysesthesias, paresthesias, dry eye, deafferentation pain, and keratitis. Hypesthesia and paresthesia occurred as complications only when the anterior retrogasserian portion of the trigeminal nerve was targeted, whereas the other listed complications occurred when the root entry zone was targeted. Recurrence rates ranged from 0% to 52.2% (mean 24.6%, median 23%) for GKS, from 19% to 63% (mean 32.2%, median 29%) for LINAC, and from 15.8% to 33% (mean 25.8%, median 27.2%) for CKR. Two GKS series reported 30% and 45.3% of patients who were pain free without medication at 10 years. CONCLUSIONS The literature is limited in its level of evidence, with only one comparative randomized trial (1 vs 2 isocenters) reported to date. At present, one can conclude that RS is a safe and effective therapy for drug-resistant trigeminal neuralgia. A number of consensus statements have been made and endorsed by the ISRS.

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“…This may be attributed to the lower maximum radiation dose, a patient experience of less intensity, or insufficient follow-up. A recent study by Karam et al [3] evaluated GKRS outcomes in TN patients and noted a significant correlation between age and pain recurrence. They reported an increased likelihood of a favorable outcome in patients >70 years of age.…”

Section: Discussionmentioning

confidence: 99%

“…For higher-risk elderly patients, stereotactic radiosurgery (SRS) offers the least invasive option. Although several studies suggested that SRS is an effective surgical option [3,4], the safety and efficacy of SRS in TN patients at least 70 years of age have not been reported. This study aimed to evaluate the outcomes after one or more SRS procedures in this population.…”

Section: Introductionmentioning

confidence: 99%

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

Cohen

Mousavi

Faraji

et al. 2017

Stereotact Funct Neurosurg

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Background: Management of older patients with medically refractory trigeminal neuralgia (TN) is yet a matter of debate. Objective: We sought to determine the benefit of stereotactic radiosurgery (SRS) as the sole surgical management in older patients (≥70 years). Methods: One hundred and twenty-seven patients (≥70 years) with typical TN underwent SRS as initial surgical management. The median maximum dose for the first procedure was 80 Gy. Repeat SRS was performed in 46 patients who developed recurrent pain. Results: After the first SRS, the initial pain control was achieved in 91% of patients. Complete pain relief (Barrow Neurological Institute [BNI] score I) developed in 75 patients (59%) and was maintained in 59, 39, and 22% of patients at 1, 3, and 5 years. Following repeat SRS, the rate of complete pain relief was 79, 55, and 41% at 1, 3, and 5 years. The chance of BNI I preservation was greater after repeat SRS compared to initial SRS (hazards ratio: 2.02, p < 0.0001). The incidence of trigeminal sensory loss was 17% after initial SRS but increased to 39% after repeat SRS. Conclusions: SRS alone was used effectively in older TN patients to achieve pain control. Recurrent pain responded to retreatment but was associated with an increased risk of sensory dysfunction.

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Trigeminal neuralgia treatment outcomes following Gamma Knife radiosurgery with a minimum 3-year follow-up

Cited by 26 publications

References 21 publications

Higher dose rate Gamma Knife radiosurgery may provide earlier and longer-lasting pain relief for patients with trigeminal neuralgia

Higher dose rate Gamma Knife radiosurgery may provide earlier and longer-lasting pain relief for patients with trigeminal neuralgia

Stereotactic radiosurgery for trigeminal neuralgia: a systematic review

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

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