Trigeminal nerve dysfunction after Gamma Knife surgery for trigeminal neuralgia: a detailed analysis

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Object

Gamma Knife surgery (GKS) is an effective treatment option for intractable trigeminal neuralgia (TN). The incidence of trigeminal nerve dysfunction, such as facial numbness or dysesthesia, has been reported to be higher than previously published, and the degree and prognosis of trigeminal nerve dysfunction has not been well evaluated. The authors evaluated the incidence, timing, degree, and outcome of trigeminal nerve dysfunction after GKS for TN.

Methods

One hundred four patients with medically refractory TN were treated by GKS. Thirty-nine patients were men and 65 were women; their median age at GKS was 74 years. Using a single isocenter and a 4-mm collimator, 80 or 90 Gy was directed to the trigeminal nerve root. Follow-up data were obtained at clinical examinations every 3–6 months after GKS. Each patient's pain-control status and degree of trigeminal nerve dysfunction were recorded. The incidence, timing, and degree of dysfunction (assessed using the Barrow Neurological Institute facial numbness scale [BNI-N]) and the prognosis and factors related to trigeminal nerve dysfunction were analyzed.

Results

The median duration of follow-up in these patients was 37 months (range 6–121 months). At the final clinical visit, a pain-free status was still observed in 71 patients (68.3%). In 51 patients (49.0%), new or increased trigeminal nerve dysfunction developed at a median of 10.5 months (range 4–68 months) after GKS. In 24 patients (23.1%), this dysfunction was categorized as BNI-N Score II, in 20 patients (19.2%) as BNI-N Score III, and in 7 patients (6.7%) as BNI-N Score IV. Among those patients, 18 patients, including 3 patients with BNI-N Score IV, experienced improvement in nerve dysfunction between 24 and 108 months after GKS (median 52.5 months). At the final clinical visit, 43 patients (41.3%) reported having some trigeminal nerve dysfunction: in 26 patients (25.0%) this was categorized as BNI-N Score II, in 13 patients (12.5%) as BNI-N Score III, and in 4 patients (3.8%) as BNI-N Score IV. The only independent factor that was correlated to all trigeminal nerve dysfunction and also specifically to bothersome trigeminal nerve dysfunction was pain-free status at the final clinic visit.

Conclusions

The incidence of trigeminal nerve dysfunction after GKS for TN was 49%. The severity of the dysfunction improved in one-third of the afflicted patients, even in those with severe dysesthesia at long-term follow-up. A strong relationship between TN and good pain control was identified.

Abbreviations used in this paper: BNI = Barrow Neurological Institute; BNI-N = BNI facial numbness scale; BNI-P = BNI pain intensity scale; CISS = constructive interference in the steady state; DREZ = dorsal root entry zone; GKS = Gamma Knife surgery; TN = trigeminal neuralgia.

Article Information

Address correspondence to: Shinji Matsuda, M.D., Gamma Knife Center, Chiba Cardiovascular Center, 575, Tsurumai, Ichihara, Chiba Prefecture, 290-0512, Japan. email: sinji-m@syd.odn.ne.jp.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    The dose plan used in Case 22 (left), and the dose plan used in Case 80 (right). The circles indicate the 80%, 20%, and 17% isodose lines of the maximum dose.

  • View in gallery

    The schema of the time course of trigeminal nerve dysfunction.

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