Stereotactic gamma knife surgery for trigeminal neuralgia: detailed analysis of treatment response

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  • 1 Departments of Neurosurgery, Radiation Oncology, Radiation Physics, and Diagnostic Radiology, Roswell Park Cancer Institute and State University of New York School of Medicine and Biomedical Sciences, Buffalo, New York
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Object. The purpose of this study was to assess the durability and completeness of pain relief in patients treated using stereotactic gamma knife surgery (GKS) for trigeminal neuralgia (TN).

Methods. Thirty-eight patients with refractory TN were treated with stereotactic GKS. All patients received a prescription radiation dose of 35, 40, or 45 Gy to the 50% isodose surface through a 4-mm collimator helmet. The group was assessed regularly based on physician-directed interviews for a median follow up of 24 months (range 6–27 months). Pain relief was classified as excellent (no pain without medication), good (well-controlled pain with continued medication), fair (decreased but residual pain with continued medication), or poor (unimproved or increased pain with the same or increased medication).

Three months after treatment, pain relief was good or excellent in 71% of patients. By 24 months post-GKS, 50% of the original cohort had poor pain relief, 21% continued to have either excellent or good relief, 3% had fair relief, and 26% had not reached the 24-month follow up. Based on their status at the last follow up, 29% of patients had excellent and 16% had good pain relief. Thirty-seven percent experienced facial numbness, which was dose related. In addition, there was a significantly higher rate of complete pain relief in patients who had facial numbness following treatment (p = 0.003).

Conclusions. Stereotactic GKS is an effective treatment in patients with TN; however, the durability of pain relief and the time to treatment response are limiting factors. As with other types of ablative treatment, facial numbness is strongly associated with better treatment response.

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Contributor Notes

Address reprint requests to: Robert A. Fenstermaker, M.D., Department of Neurosurgery, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, New York 14263. email: Robert.Fenstermaker@RoswellPark.org.
  • 1

    Alberico RA, , Fenstermaker RA, & Lobel J: Focal enhancement of cranial nerve V after radiosurgery with the Leksell gamma knife: experience in 15 patients with medically refractory trigeminal neuralgia. AJNR 22:19441948, 2001 Alberico RA, Fenstermaker RA, Lobel J: Focal enhancement of cranial nerve V after radiosurgery with the Leksell gamma knife: experience in 15 patients with medically refractory trigeminal neuralgia. AJNR 22:1944–1948, 2001

    • Search Google Scholar
    • Export Citation
  • 2

    Barker FG, , Jannetta PJ, , Bissonette DJ, , Larkins MV, & Jho HD: The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334:10771084, 1996 Barker FG, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD: The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334:1077–1084, 1996

    • Search Google Scholar
    • Export Citation
  • 3

    Brisman R: Gamma knife radiosurgery for primary management for trigeminal neuralgia. J Neurosurg 93 (Suppl 3):159161, 2000 Brisman R: Gamma knife radiosurgery for primary management for trigeminal neuralgia. J Neurosurg 93 (Suppl 3):159–161, 2000

    • Search Google Scholar
    • Export Citation
  • 4

    Brisman R: Gamma knife surgery with a dose of 75 to 76.8 Gray for trigeminal neuralgia. J Neurosurg 100:848854, 2004 Brisman R: Gamma knife surgery with a dose of 75 to 76.8 Gray for trigeminal neuralgia. J Neurosurg 100:848–854, 2004

    • Search Google Scholar
    • Export Citation
  • 5

    Brisman R, , Khandji AG, & Mooij RB: Trigeminal nerve-blood vessel relationship as revealed by high-resolution magnetic resonance imaging and its effect on pain relief after gamma knife radiosurgery for trigeminal neuralgia. Neurosurgery 50:12611267, 2002 Brisman R, Khandji AG, Mooij RB: Trigeminal nerve-blood vessel relationship as revealed by high-resolution magnetic resonance imaging and its effect on pain relief after gamma knife radiosurgery for trigeminal neuralgia. Neurosurgery 50:1261–1267, 2002

    • Search Google Scholar
    • Export Citation
  • 6

    Brisman R, & Mooij R: Gamma knife radiosurgery for trigeminal neuralgia: dose-volume histograms of the brainstem and trigeminal nerve. J Neurosurg 93 (Suppl 3):155158, 2000 Brisman R, Mooij R: Gamma knife radiosurgery for trigeminal neuralgia: dose-volume histograms of the brainstem and trigeminal nerve. J Neurosurg 93 (Suppl 3):155–158, 2000

    • Search Google Scholar
    • Export Citation
  • 7

    Brown JA, , McDaniel MD, & Weaver MT: Percutaneous trigeminal nerve compression for treatment of trigeminal neuralgia: results in 50 patients. Neurosurgery 32:570573, 1993 Brown JA, McDaniel MD, Weaver MT: Percutaneous trigeminal nerve compression for treatment of trigeminal neuralgia: results in 50 patients. Neurosurgery 32:570–573, 1993

    • Search Google Scholar
    • Export Citation
  • 8

    Burchiel KJ: Abnormal impulse generation in focally demyelinated trigeminal roots. J Neurosurg 53:674683, 1980 Burchiel KJ: Abnormal impulse generation in focally demyelinated trigeminal roots. J Neurosurg 53:674–683, 1980

    • Search Google Scholar
    • Export Citation
  • 9

    Burchiel KJ, , Clarke H, , Haglund M, & Loeser JD: Long-term efficacy of microvascular decompression in trigeminal neuralgia. J Neurosurg 69:3538, 1988 Burchiel KJ, Clarke H, Haglund M, Loeser JD: Long-term efficacy of microvascular decompression in trigeminal neuralgia. J Neurosurg 69:35–38, 1988

    • Search Google Scholar
    • Export Citation
  • 10

    Burchiel KJ, & Slavin KV: On the natural history of trigeminal neuralgia. Neurosurgery 46:152155, 2000 Burchiel KJ, Slavin KV: On the natural history of trigeminal neuralgia. Neurosurgery 46:152–155, 2000

    • Search Google Scholar
    • Export Citation
  • 11

    Chang JW, , Chang JH, , Park YG, & Chung SS: Gamma knife radiosurgery for idiopathic and secondary trigeminal neuralgia. J Neurosurg 93 (Suppl 3):147151, 2000 Chang JW, Chang JH, Park YG, Chung SS: Gamma knife radiosurgery for idiopathic and secondary trigeminal neuralgia. J Neurosurg 93 (Suppl 3):147–151, 2000

    • Search Google Scholar
    • Export Citation
  • 12

    Flickinger JC, , Pollock BE, , Kondziolka D, , Phuong LK, , Foote RL, & Stafford SL, et al: Does increased nerve length within the treatment volume improve trigeminal neuralgia radiosurgery? A prospective double-blind, randomized study. Int J Radiat Oncol Biol Phys 51:449454, 2001 Flickinger JC, Pollock BE, Kondziolka D, Phuong LK, Foote RL, Stafford SL, et al: Does increased nerve length within the treatment volume improve trigeminal neuralgia radiosurgery? A prospective double-blind, randomized study. Int J Radiat Oncol Biol Phys 51:449–454, 2001

    • Search Google Scholar
    • Export Citation
  • 13

    Hardy DG, & Rhoton AL Jr: Microsurgical relationships of the superior cerebellar artery and the trigeminal nerve. J Neurosurg 49:669678, 1978 Hardy DG, Rhoton AL Jr: Microsurgical relationships of the superior cerebellar artery and the trigeminal nerve. J Neurosurg 49:669–678, 1978

    • Search Google Scholar
    • Export Citation
  • 14

    Hasegawa T, , Kondziolka D, , Spiro R, , Flickinger JC, & Lunsford CD: Repeat radiosurgery for refractory trigeminal neuralgia. Neurosurgery 50:494502, 2002 Hasegawa T, Kondziolka D, Spiro R, Flickinger JC, Lunsford CD: Repeat radiosurgery for refractory trigeminal neuralgia. Neurosurgery 50:494–502, 2002

    • Search Google Scholar
    • Export Citation
  • 15

    Jannetta PJ: Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg 26 (Suppl):159162, 1967 Jannetta PJ: Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg 26 (Suppl):159–162, 1967

    • Search Google Scholar
    • Export Citation
  • 16

    Kondziolka D, , Flickinger JC, , Lunsford LD, & Habeck M: Trigeminal neuralgia radiosurgery: the University of Pittsburgh experience. Stereotact Funct Neurosurg 66 (Suppl 1):343348, 1996 Kondziolka D, Flickinger JC, Lunsford LD, Habeck M: Trigeminal neuralgia radiosurgery: the University of Pittsburgh experience. Stereotact Funct Neurosurg 66 (Suppl 1):343–348, 1996

    • Search Google Scholar
    • Export Citation
  • 17

    Kondziolka D, , Lunsford LD, , Flickinger JC, , Young RF, , Vermeulen S, & Duma CM, et al: Stereotactic radiosurgery for trigeminal neuralgia: a multiinstitutional study using the gamma unit. J Neurosurg 84:940945, 1996 Kondziolka D, Lunsford LD, Flickinger JC, Young RF, Vermeulen S, Duma CM, et al: Stereotactic radiosurgery for trigeminal neuralgia: a multiinstitutional study using the gamma unit. J Neurosurg 84:940–945, 1996

    • Search Google Scholar
    • Export Citation
  • 18

    Kondziolka D, , Perez B, , Flickinger JC, , Habeck M, & Lunsford LD: Gamma knife radiosurgery for trigeminal neuralgia: results and expectations. Arch Neurol 55:15241529, 1998 Kondziolka D, Perez B, Flickinger JC, Habeck M, Lunsford LD: Gamma knife radiosurgery for trigeminal neuralgia: results and expectations. Arch Neurol 55:1524–1529, 1998

    • Search Google Scholar
    • Export Citation
  • 19

    Maesawa S, , Salame C, , Flickinger JC, , Pirris S, , Kondziolka D, & Lunsford LD: Clinical outcomes after stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 94:1420, 2001 Maesawa S, Salame C, Flickinger JC, Pirris S, Kondziolka D, Lunsford LD: Clinical outcomes after stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 94:14–20, 2001

    • Search Google Scholar
    • Export Citation
  • 20

    Massager N, , Lorenzoni J, , Devriendt D, , Desmedt F, , Brotchi J, & Levivier M: Gamma knife surgery for idiopathic trigeminal neuralgia performed using a far-anterior cisternal target and a high dose of radiation. J Neurosurg 100:597605, 2004 Massager N, Lorenzoni J, Devriendt D, Desmedt F, Brotchi J, Levivier M: Gamma knife surgery for idiopathic trigeminal neuralgia performed using a far-anterior cisternal target and a high dose of radiation. J Neurosurg 100:597–605, 2004

    • Search Google Scholar
    • Export Citation
  • 21

    Matsuda S, , Serizawa T, , Sato M, & Ono J: Gamma knife radiosurgery for trigeminal neuralgia: the dry-eye complication. J Neurosurg 97:525528, 2002 Matsuda S, Serizawa T, Sato M, Ono J: Gamma knife radiosurgery for trigeminal neuralgia: the dry-eye complication. J Neurosurg 97:525–528, 2002

    • Search Google Scholar
    • Export Citation
  • 22

    Nizin PS: On absorbed dose in narrow 60Co gamma-ray beams and dosimetry of the gamma knife. Med Phys 25:23472351, 1998 Nizin PS: On absorbed dose in narrow 60Co gamma-ray beams and dosimetry of the gamma knife. Med Phys 25:2347–2351, 1998

    • Search Google Scholar
    • Export Citation
  • 23

    Petit JH, , Herman JM, , Biggins T, , Regine W, & Chin LS: Repeat gamma knife radiosurgery for refractory or recurrent trigeminal neuralgia. Int J Radiat Oncol Biol Phys 57:S137, 2003 (Abstract) Petit JH, Herman JM, Biggins T, Regine W, Chin LS: Repeat gamma knife radiosurgery for refractory or recurrent trigeminal neuralgia. Int J Radiat Oncol Biol Phys 57:S137, 2003 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 24

    Petit JH, , Herman JM, , Nagda S, , DiBiase SJ, & Chin LS: Radiosurgical treatment of trigeminal neuralgia: evaluating quality of life and treatment outcomes. Int J Radiat Oncol Biol Phys 56:11471153, 2003 Petit JH, Herman JM, Nagda S, DiBiase SJ, Chin LS: Radiosurgical treatment of trigeminal neuralgia: evaluating quality of life and treatment outcomes. Int J Radiat Oncol Biol Phys 56:1147–1153, 2003

    • Search Google Scholar
    • Export Citation
  • 25

    Pollock BE, , Foote RL, , Stafford SL, , Link MJ, , Gorman DA, & Schomberg PJ: Results of repeated gamma knife radiosurgery for medically unresponsive trigeminal neuralgia. J Neurosurg 93 (Suppl 3):162164, 2000 Pollock BE, Foote RL, Stafford SL, Link MJ, Gorman DA, Schomberg PJ: Results of repeated gamma knife radiosurgery for medically unresponsive trigeminal neuralgia. J Neurosurg 93 (Suppl 3):162–164, 2000

    • Search Google Scholar
    • Export Citation
  • 26

    Pollock BE, , Phuong LK, , Foote RL, , Stafford SL, & Gorman DA: High-dose trigeminal neuralgia radiosurgery associated with increased risk of trigeminal nerve dysfunction. Neurosurgery 49:5864, 2001 Pollock BE, Phuong LK, Foote RL, Stafford SL, Gorman DA: High-dose trigeminal neuralgia radiosurgery associated with increased risk of trigeminal nerve dysfunction. Neurosurgery 49:58–64, 2001

    • Search Google Scholar
    • Export Citation
  • 27

    Pollock BE, , Phuong LK, , Gorman DA, , Foote RL, & Stafford SL: Stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 97:347353, 2002 Pollock BE, Phuong LK, Gorman DA, Foote RL, Stafford SL: Stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 97:347–353, 2002

    • Search Google Scholar
    • Export Citation
  • 28

    Regis J, , Bartolomei F, , Metellus P, , Rey M, , Genton P, & Dravet C, et al: Radiosurgery for trigeminal neuralgia and epilepsy. Neurosurg Clin N Am 10:359377, 1999 Regis J, Bartolomei F, Metellus P, Rey M, Genton P, Dravet C, et al: Radiosurgery for trigeminal neuralgia and epilepsy. Neurosurg Clin N Am 10:359–377, 1999

    • Search Google Scholar
    • Export Citation
  • 29

    Rogers CL, , Shetter AG, , Fiedler JA, , Smith KA, , Han PP, & Speiser BL: Gamma knife radiosurgery for trigeminal neuralgia: the initial experience of The Barrow Neurological Institute. Int J Radiat Oncol Biol Phys 47:10131019, 2000 Rogers CL, Shetter AG, Fiedler JA, Smith KA, Han PP, Speiser BL: Gamma knife radiosurgery for trigeminal neuralgia: the initial experience of The Barrow Neurological Institute. Int J Radiat Oncol Biol Phys 47:1013–1019, 2000

    • Search Google Scholar
    • Export Citation
  • 30

    Shetter AG, , Rogers CL, , Ponce F, , Fiedler JA, , Smith K, & Speiser BL: Gamma knife radiosurgery for recurrent trigeminal neuralgia. J Neurosurg 97 (Suppl 5):536538, 2002 Shetter AG, Rogers CL, Ponce F, Fiedler JA, Smith K, Speiser BL: Gamma knife radiosurgery for recurrent trigeminal neuralgia. J Neurosurg 97 (Suppl 5):536–538, 2002

    • Search Google Scholar
    • Export Citation
  • 31

    Taha JM, , Tew JM Jr, & Buncher CR: A prospective 15-year follow-up of 154 consecutive patients with trigeminal neuralgia treated by percutaneous stereotactic radiofrequency thermal rhizotomy. J Neurosurg 83:989993, 1995 Taha JM, Tew JM Jr, Buncher CR: A prospective 15-year follow-up of 154 consecutive patients with trigeminal neuralgia treated by percutaneous stereotactic radiofrequency thermal rhizotomy. J Neurosurg 83:989–993, 1995

    • Search Google Scholar
    • Export Citation
  • 32

    Wilson CB, , Yorke C, & Prioleau G: Microsurgical vascular decompression for trigeminal neuralgia and hemifacial spasm. West J Med 132:481487, 1980 Wilson CB, Yorke C, Prioleau G: Microsurgical vascular decompression for trigeminal neuralgia and hemifacial spasm. West J Med 132:481–487, 1980

    • Search Google Scholar
    • Export Citation
  • 33

    Young RF, , Jacques DS, & Mark R: Gamma Knife radiosurgery for treatment of trigeminal neuralgia: long-term results. Neurosurgery 49:533534, 2001 (Abstract) Young RF, Jacques DS, Mark R: Gamma Knife radiosurgery for treatment of trigeminal neuralgia: long-term results. Neurosurgery 49:533–534, 2001 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 34

    Young RF, , Vermeulen SS, , Grimm P, , Blasko J, & Posewitz A: Gamma Knife radiosurgery for treatment of trigeminal neuralgia: idiopathic and tumor related. Neurology 48:608614, 1997 Young RF, Vermeulen SS, Grimm P, Blasko J, Posewitz A: Gamma Knife radiosurgery for treatment of trigeminal neuralgia: idiopathic and tumor related. Neurology 48:608–614, 1997

    • Search Google Scholar
    • Export Citation

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