Prospective controlled trial of gamma knife surgery for essential trigeminal neuralgia

View More View Less
  • 1 Departments of Functional Neurosurgery and Neurology, Timone University Hospital, Marseille, France
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object

Stereotactic radiosurgery is an alternative to conventional surgery for the treatment of trigeminal neuralgia. The authors conducted a prospective evaluation of the safety and efficacy of this method in a large series of patients.

Methods

A total of 100 patients presenting with trigeminal neuralgia were treated and followed up for a minimum of 12 months. The mean age was 68.2 years; 54 patients were male, and 46 were female. Seven had a history of multiple sclerosis, and 42 had already received conventional surgical treatment for trigeminal neuralgia. The intervention consisted of gamma knife surgery to the retrogasserian cisternal portion of the fifth cranial nerve. The median dose used at the maximum was 85 Gy (range 70–90 Gy). The number and intensity of pain attacks were recorded by the patient from 3 months before radiosurgery to a minimum of 12 months after treatment. Before and a minimum of 12 months after treatment, the patient completed a quality-of-life questionnaire. Neurological examination and quantitative sensory testing to evaluate sensory perception were performed by an independent neurologist over this same time period.

At the last visit 83 of 100 patients were reported to be pain free. Fifty-eight of these 83 patients had stopped taking medication during the study. All quality-of-life parameters were improved (p < 0.001). Six patients reported facial paresthesia, and four patients reported hypesthesia. These symptoms were classified as mild. None of the complications reported for other techniques were observed.

Conclusions

Radiosurgery is a safe and effective alternative treatment for trigeminal neuralgia and is associated with a particularly low rate of hypesthesia.

Abbreviations used in this paper:CT = computerized tomography; GKS = gamma knife surgery; MR = magnetic resonance; MVD = microvascular decompression; VAS = visual analog scale.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Jean Régis, M.D., Service de Neuro-chirurgie Fonctionnelle et Stéréotaxique, 264 Blvd St Pierre, 13385 Marseille Cedex 05, France. email: jregis@ap-hm.fr.
  • 1

    Barker FG II, , Jannetta PJ, , Babu RP, , Pomonis S, , Bissonette DJ, & Dong Jho H: Long-term outcome after operation for trigeminal neuralgia in patients with posterior fossa tumors. J Neurosurg 84:818825, 1996

    • Search Google Scholar
    • Export Citation
  • 2

    Barker FG II, , Jannetta PJ, , Bissonette DJ, & Jho HD: Trigeminal numbness and tic relief after microvascular decompression for typical trigeminal neuralgia. Neurosurgery 40:3945, 1997

    • Search Google Scholar
    • Export Citation
  • 3

    Barker FG II, , Jannetta PJ, , Bissonette DJ, , Larkins MV, & Jho HD: The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334:10771083, 1996

    • Search Google Scholar
    • Export Citation
  • 4

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

  • 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 radio-surgery for trigeminal neuralgia. Neurosurgery 50:12611267, 2002

    • Search Google Scholar
    • Export Citation
  • 6

    Broggi G, , Ferroli P, , Franzini A, , Servello D, & Dones I: Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases, including 10 patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 68:5964, 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

    • Search Google Scholar
    • Export Citation
  • 8

    Chang JW, , Chang JH, , Park YG, & Chung SS: Gamma knife radio-surgery for idiopathic and secondary trigeminal neuralgia. J Neurosurg 93:Suppl 3 147151, 2000

    • Search Google Scholar
    • Export Citation
  • 9

    De Ridder D, , Moller A, , Verlooy J, , Cornelissen M, & De Ridder L: Is the root entry/exit zone important in microvascular compression syndromes?. Neurosurgery 51:427434, 2002

    • Search Google Scholar
    • Export Citation
  • 10

    Flickinger JC, , Pollock BE, , Kondziolka D, , Phuong LK, , Foote RL, & Stafford SL, : 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

    • Search Google Scholar
    • Export Citation
  • 11

    Frighetto L, , De Salles AA, , Smith ZA, , Goss B, , Selch M, & Solberg T: Noninvasive linear accelerator radiosurgery as the primary treatment for trigeminal neuralgia. Neurology 62:660662, 2004

    • Search Google Scholar
    • Export Citation
  • 12

    Goss BW, , Frighetto L, , DeSalles AA, , Smith Z, , Solberg T, & Selch M: Linear accelerator radiosurgery using 90 gray for essential trigeminal neuralgia: results and dose volume histogram analysis. Neurosurgery 53:823830, 2003

    • Search Google Scholar
    • Export Citation
  • 13

    Han PP, , Shetter AG, , Smith KA, , Fiedler JA, , Rogers CL, & Speiser B, : Gamma knife radiosurgery for trigeminal neuralgia: experience at the Barrow Neurological Institute. Stereotact Funct Neurosurg 73:131133, 1999

    • Search Google Scholar
    • Export Citation
  • 14

    Headache Classification Subcommittee of the International Headache Society: The international classification and diagnostic criteria for headache disorders, cranial neuralgia and facial pain, ed 2. Cephalalgia 24:Suppl 1 9160, 2004

    • Search Google Scholar
    • Export Citation
  • 15

    Huang E, , Teh BS, , Zeck O, , Woo SY, , Lu HH, & Chiu JK, : Gamma knife radiosurgery for treatment of trigeminal neuralgia in multiple sclerosis patients. Stereotact Funct Neurosurg 79:4450, 2002

    • Search Google Scholar
    • Export Citation
  • 16

    Jawahar A, , Kondziolka D, , Kanal E, , Bissonette DJ, & Lunsford LD: Imaging the trigeminal nerve and pons before and after surgical intervention for trigeminal neuralgia. Neurosurgery 48:101107, 2001

    • Search Google Scholar
    • Export Citation
  • 17

    Kannan V, , Deopujari CE, , Misra BK, , Shetty PG, , Shroff MM, & Pendse AM: Gamma-knife radiosurgery for trigeminal neuralgia. Australas Radiol 43:339341, 1999

    • Search Google Scholar
    • Export Citation
  • 18

    Kanner AA, , Neyman G, , Suh JH, , Weinhous MS, , Lee SY, & Barnett GH: Gamma knife radiosurgery for trigeminal neuralgia: comparing the use of a 4-mm versus concentric 4– and 8-mm collimators. Stereotact Funct Neurosurg 82:4957, 2004

    • Search Google Scholar
    • Export Citation
  • 19

    Kanpolat Y, , Savas A, , Bekar A, & Berk C: Percutaneous controlled radiofrequency trigeminal rhizotomy for the treatment of idiopathic trigeminal neuralgia: 25-year experience with 1,600 patients. Neurosurgery 48:524534, 2001

    • Search Google Scholar
    • Export Citation
  • 20

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

    • Search Google Scholar
    • Export Citation
  • 21

    Kondziolka D, , Lunsford LD, & Flickinger JC: Gamma knife radio-surgery as the first surgery for trigeminal neuralgia. Stereotact Funct Neurosurg 70:Suppl 1 187191, 1998

    • Search Google Scholar
    • Export Citation
  • 22

    Kondziolka D, , Lunsford LD, & Flickinger JC: Stereotactic radio-surgery for the treatment of trigeminal neuralgia. Clin J Pain 18:4247, 2002

    • Search Google Scholar
    • Export Citation
  • 23

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

    • Search Google Scholar
    • Export Citation
  • 24

    Kondziolka D, , Lunsford LD, , Habeck M, & Flickinger JC: Gamma knife radiosurgery for trigeminal neuralgia. Neurosurg Clin N Am 8:7985, 1997

    • Search Google Scholar
    • Export Citation
  • 25

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

    • Search Google Scholar
    • Export Citation
  • 26

    Kondziolka D, , Perez B, , Flickinger JC, & Lunsford LD, Gamma knife radiosurgery for trigeminal neuralgia. Lunsford LD, , Kondziolka D, & Flickinger JC: Progress in Neurological Surgery: Gamma Knife Brain Surgery Basel, Karger, 14:212221, 1998

    • Search Google Scholar
    • Export Citation
  • 27

    Latchaw JP Jr, , Hardy RW Jr, , Forsythe SB, & Cook AF: Trigeminal neuralgia treated by radiofrequency coagulation. J Neurosurg 59:479484, 1983

    • Search Google Scholar
    • Export Citation
  • 28

    Leksell L: Stereotaxic radiosurgery in trigeminal neuralgia. Acta Chir Scand 137:311314, 1971

  • 29

    Leksell L: Stereotaxis and radiosurgery. An Operative System Springfield, IL, Charles C Thomas, 1971

  • 30

    Lindquist C, , Kihlstrom L, & Hellstrand E: Functional neurosurgery—a future for the gamma knife?. Stereotact Funct Neurosurg 57:7281, 1991

    • Search Google Scholar
    • Export Citation
  • 31

    Lopez BC, , Hamlyn PJ, & Zakrzewska JM: Stereotactic radiosurgery for primary trigeminal neuralgia: state of the evidence and recommendations for future reports. J Neurol Neurosurg Psychiatry 75:10191024, 2004

    • Search Google Scholar
    • Export Citation
  • 32

    Lopez BC, , Hamlyn PJ, & Zakrzewska JM: Systematic review of ablative neurosurgical techniques for the treatment of trigeminal neuralgia. Neurosurgery 54:973983, 2004

    • Search Google Scholar
    • Export Citation
  • 33

    Love S, & Coakham HB: Trigeminal neuralgia: pathology and pathogenesis. Brain 124:23472360, 2001

  • 34

    Lunsford LD, & Young RF: Radiosurgery for trigeminal neuralgia. Surg Neurol 54:285287, 2000

  • 35

    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

    • Search Google Scholar
    • Export Citation
  • 36

    Maher CO, & Pollock BE: Radiation induced vascular injury after stereotactic radiosurgery for trigeminal neuralgia: case report. Surg Neurol 54:189193, 2000

    • Search Google Scholar
    • Export Citation
  • 37

    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

    • Search Google Scholar
    • Export Citation
  • 38

    Matsuda S, , Serizawa T, , Sato M, & Ono J: Gamma knife radiosurgery for trigeminal neuralgia: the dry-eye complication. J Neurosurg 97:5 Suppl 525528, 2002

    • Search Google Scholar
    • Export Citation
  • 39

    McLaughlin MR, , Jannetta PJ, , Clyde BL, , Subach BR, , Comey CH, & Resnick DK: Microvascular decompression of cranial nerves: lessons learned after 4400 operations. J Neurosurg 90:18, 1999

    • Search Google Scholar
    • Export Citation
  • 40

    Mehta V, , Meier R, , Gilrein J, , Vermeulen S, & Young R: Gamma knife radiosurgery for treatment of trigeminal neuralgia. Int J Radiat Oncol Biol Phys 57:2 Suppl S136, 2003

    • Search Google Scholar
    • Export Citation
  • 41

    Merrison AF, & Fuller G: Treatment options for trigeminal neuralgia. BMJ 327:13601361, 2003

  • 42

    Nicol B, , Regine WF, , Courtney C, , Meigooni A, , Sanders M, & Young B: Gamma knife radiosurgery using 90 Gy for trigeminal neuralgia. J Neurosurg 93:(Suppl 3) 152154, 2000

    • Search Google Scholar
    • Export Citation
  • 43

    North RB, , Kidd DH, , Piantadosi S, & Carson BS: Percutaneous ret-rogasserian glycerol rhizotomy. Predictors of success and failure in treatment of trigeminal neuralgia. J Neurosurg 72:851856, 1990

    • Search Google Scholar
    • Export Citation
  • 44

    Nurmikko T: Clinical features and pathophysiologic mechanisms of postherpetic neuralgia. Neurology 45:12 Suppl 8 S54S55, 1995

  • 45

    Oturai AB, , Jensen K, , Eriksen J, & Madsen F: Neurosurgery for trigeminal neuralgia: comparison of alcohol block, neurectomy, and radiofrequency coagulation. Clin J Pain 12:311315, 1996

    • Search Google Scholar
    • Export Citation
  • 46

    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

    • Search Google Scholar
    • Export Citation
  • 47

    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

    • Search Google Scholar
    • Export Citation
  • 48

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

    • Search Google Scholar
    • Export Citation
  • 49

    Rand RW: Leksell Gamma Knife treatment of tic douloureux. Neurosurg Clin N Am 8:7578, 1997

  • 50

    Rand RW, , Jacques DB, , Melbye RW, , Copcutt BG, , Levenick MN, & Fisher MR: Leksell Gamma Knife treatment of tic douloureux. Stereotact Funct Neurosurg 61:Suppl 1 1188, 1993

    • Search Google Scholar
    • Export Citation
  • 51

    Régis J, , Bartolomei F, , Metellus P, , Rey M, , Genton P, & Dravet C, : Radiosurgery for trigeminal neuralgia and epilepsy. Neurosurg Clin N Am 10:359377, 1999

    • Search Google Scholar
    • Export Citation
  • 52

    Régis J, , Manera L, , Dufour H, , Porcheron D, , Sedan R, & Peragut JC: Effect of the Gamma Knife on trigeminal neuralgia. Stereotact Funct Neurosurg 64:Suppl 1 182192, 1995

    • Search Google Scholar
    • Export Citation
  • 53

    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

    • Search Google Scholar
    • Export Citation
  • 54

    Rogers CL, , Shetter AG, , Ponce FA, , Fiedler JA, , Smith KA, & Speiser BL: Gamma knife radiosurgery for trigeminal neuralgia associated with multiple sclerosis. J Neurosurg 97:5 Suppl 529532, 2002

    • Search Google Scholar
    • Export Citation
  • 55

    Romanelli P, , Heit G, , Chang SD, , Martin D, , Pham C, & Adler J: Cyberknife radiosurgery for trigeminal neuralgia. Stereotact Funct Neurosurg 81:105109, 2003

    • Search Google Scholar
    • Export Citation
  • 56

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

    • Search Google Scholar
    • Export Citation
  • 57

    Siegfried J: 500 Percutaneous thermocoagulations of the Gasserian ganglion for trigeminal pain. Surg Neurol 8:126131, 1977

  • 58

    Sinay VJ, , Bonamico LH, & Dubrovsky A: Subclinical sensory abnormalities in trigeminal neuralgia. Cephalalgia 23:541544, 2003

  • 59

    Sindou M, , Keravel Y, , Abdennebi B, & Szapiro J: Traitement neuro-chirurgical de la névralgie trigéminale. Neurochirurgie 33:89111, 1987

    • Search Google Scholar
    • Export Citation
  • 60

    Slettebo H, , Hirschberg H, & Lindegaard KF: Long-term results after percutaneous retrogasserian glycerol rhizotomy in patients with trigeminal neuralgia. Acta Neurochir (Wien) 122:231235, 1993

    • Search Google Scholar
    • Export Citation
  • 61

    Smith ZA, , De Salles AA, , Frighetto L, , Goss B, , Lee SP, & Selch M, : Dedicated linear accelerator radiosurgery for the treatment of trigeminal neuralgia. J Neurosurg 99:511516, 2003

    • Search Google Scholar
    • Export Citation
  • 62

    Taarnhoj P: Decompression of the trigeminal root and the posterior part of the ganglion as treatment in trigeminal neuralgia; preliminary communication. J Neurosurg 9:288290, 1952

    • Search Google Scholar
    • Export Citation
  • 63

    Urgosik D, , Vymazal J, , Vladyka V, & Liscak R: Gamma knife treatment of trigeminal neuralgia: clinical and electrophysiological study. Stereotact Funct Neurosurg 70:Suppl 1 200209, 1998

    • Search Google Scholar
    • Export Citation
  • 64

    Verdugo R, & Ochoa JL: Quantitative somatosensory thermotest. A key method for functional evaluation of small caliber afferent channels Brain 115:Pt 3 893913, 1992

    • Search Google Scholar
    • Export Citation
  • 65

    Vickrey BG, , Hays RD, , Graber J, , Rausch R, , Engel J Jr, & Brook RH: A health-related quality of life instrument for patients evaluated for epilepsy surgery. Med Care 30:299319, 1992

    • Search Google Scholar
    • Export Citation
  • 66

    Vickrey BG, , Hays RD, , Rausch R, , Engel J Jr, , Visscher BR, & Ary CM, : Outcome in 248 patients who had diagnostic evaluations for epilepsy surgery. Lancet 346:14451449, 1995

    • Search Google Scholar
    • Export Citation
  • 67

    Yarnitsky D, , Kunin M, , Brik R, & Sprecher E: Vibration reduces thermal pain in adjacent dermatomes. Pain 69:7577, 1997

  • 68

    Young RF: Functional neurosurgery with the Leksell Gamma knife. Stereotact Funct Neurosurg 66:1923, 1996

  • 69

    Young RF, , Vermeulen S, & Posewitz A: Gamma knife radiosurgery for the treatment of trigeminal neuralgia. Stereotact Funct Neurosurg 70:Suppl 1 192199, 1998

    • Search Google Scholar
    • Export Citation
  • 70

    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

    • Search Google Scholar
    • Export Citation
  • 71

    Zakrzewska JM, , Jassim S, & Bulman JS: A prospective, longitudinal study on patients with trigeminal neuralgia who underwent radio-frequency thermocoagulation of the Gasserian ganglion. Pain 79:5158, 1999

    • Search Google Scholar
    • Export Citation
  • 72

    Zakrzewska JM, & Lopez BC: Quality of reporting in evaluations of surgical treatment of trigeminal neuralgia: recommendations for future reports. Neurosurgery 53:110122, 2003

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 958 591 14
Full Text Views 217 41 3
PDF Downloads 88 20 2
EPUB Downloads 0 0 0