Impact of target location on the response of trigeminal neuralgia to stereotactic radiosurgery

Clinical article

Restricted access

Object

The authors evaluate the impact of target location on the rate of pain relief (PR) in patients with intractable trigeminal neuralgia (TN) undergoing stereotactic radiosurgery (SRS).

Methods

The authors conducted a retrospective review of 99 patients with idiopathic TN who were identified from a prospectively maintained database and were treated with SRS targeting the dorsal root entry zone with a maximum dose of 80 Gy. Targeting of the more proximal portion of a trigeminal nerve with the 50% isodose line overlapping the brainstem was performed in 36 patients (proximal group). In a matched group, 63 patients received SRS targeting the 20% isodose line tangential to the emergence of the brainstem (distal group). The median follow-up time was 33 months (range 6–124 months).

Results

The actuarial rate of maintenance of Barrow Neurological Institute (BNI) Pain Score I–IIIa was attained in 89% of patients at 1 year, 81% at 2 years, and 69% at 4 years, respectively, after SRS. Kaplan-Meier analysis revealed that durability of PR was only associated with the proximal location of the radiosurgical target (log-rank test, p = 0.018). Radiosurgery-induced facial numbness (BNI Score II or III) developed in 35 patients, which was significantly more frequent in the proximal group (19 patients [53%] compared with 16 [25%] in the distal group [p = 0.015]).

Conclusions

The radiosurgical target appears to affect the duration of pain relief in patients with idiopathic trigeminal neuralgia with the target closer to the brainstem affording extended pain relief. However, the proximal SRS target was also associated with an increased risk of mild to moderate facial numbness.

Abbreviations used in this paper:BNI = Barrow Neurological Institute; DREZ = dorsal root entry zone; GKRS = Gamma Knife radiosurgery; MVD = microvascular decompression; PR = pain relief; RGZ = retrogasserian zone; SRS = stereotactic radiosurgery; TN = trigeminal neuralgia.
Article Information

Contributor Notes

Address correspondence to: Jason Sheehan, M.D., Ph.D., Lars Leksell Gamma Knife Center, Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA 22908. email: jsheehan@virginia.edu.Please include this information when citing this paper: published online December 6, 2013; DOI: 10.3171/2013.10.JNS131596.

© AANS, except where prohibited by US copyright law.

Headings
References
  • 1

    Barker FG IIJannetta PJBissonette DJLarkins MVJho HD: The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334:107710831996

    • Search Google Scholar
    • Export Citation
  • 2

    Brisman R: Microvascular decompression vs. gamma knife radiosurgery for typical trigeminal neuralgia: preliminary findings. Stereotact Funct Neurosurg 85:94982007

    • Search Google Scholar
    • Export Citation
  • 3

    De Ridder DMøller AVerlooy JCornelissen MDe Ridder L: Is the root entry/exit zone important in microvascular compression syndromes?. Neurosurgery 51:4274342002

    • Search Google Scholar
    • Export Citation
  • 4

    Flickinger JCPollock BEKondziolka DPhuong LKFoote RLStafford 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 51:4494542001

    • Search Google Scholar
    • Export Citation
  • 5

    Gorgulho A: Radiation mechanisms of pain control in classical trigeminal neuralgia. Surg Neurol Int 3:Suppl 1S17S252012

  • 6

    Kanner AANeyman GSuh JHWeinhous MSLee SYBarnett GH: Gamma knife radiosurgery for trigeminal neuralgia: comparing the use of a 4-mm versus concentric 4- and 8-mm collimators. Stereotact Funct Neurosurg 82:49572004

    • Search Google Scholar
    • Export Citation
  • 7

    Kim YHKim DGKim JWKim YHHan JHChung HT: Is it effective to raise the irradiation dose from 80 to 85 Gy in gamma knife radiosurgery for trigeminal neuralgia?. Stereotact Funct Neurosurg 88:1691762010

    • Search Google Scholar
    • Export Citation
  • 8

    Kondziolka DLunsford LDFlickinger JCYoung RFVermeulen SDuma CM: Stereotactic radiosurgery for trigeminal neuralgia: a multiinstitutional study using the gamma unit. J Neurosurg 84:9409451996

    • Search Google Scholar
    • Export Citation
  • 9

    Kondziolka DZorro OLobato-Polo JKano HFlannery TJFlickinger JC: Gamma Knife stereotactic radiosurgery for idiopathic trigeminal neuralgia. Clinical article. J Neurosurg 112:7587652010

    • Search Google Scholar
    • Export Citation
  • 10

    Leksell L: Sterotaxic radiosurgery in trigeminal neuralgia. Acta Chir Scand 137:3113141971

  • 11

    Love SCoakham HB: Trigeminal neuralgia: pathology and pathogenesis. Brain 124:234723602001

  • 12

    Marshall KChan MDMcCoy TPAubuchon ACBourland JDMcMullen KP: Predictive variables for the successful treatment of trigeminal neuralgia with gamma knife radiosurgery. Neurosurgery 70:5665732012

    • Search Google Scholar
    • Export Citation
  • 13

    Massager NLorenzoni JDevriendt DDesmedt FBrotchi JLevivier M: Gamma knife surgery for idiopathic trigeminal neuralgia performed using a far-anterior cisternal target and a high dose of radiation. J Neurosurg 100:5976052004

    • Search Google Scholar
    • Export Citation
  • 14

    Matsuda SSerizawa TNagano OOno J: Comparison of the results of 2 targeting methods in Gamma Knife surgery for trigeminal neuralgia. J Neurosurg 109:Suppl1851892008

    • Search Google Scholar
    • Export Citation
  • 15

    Park SHHwang SKKang DHPark JHwang JHSung JK: The retrogasserian zone versus dorsal root entry zone: comparison of two targeting techniques of gamma knife radiosurgery for trigeminal neuralgia. Acta Neurochir (Wien) 152:116511702010

    • Search Google Scholar
    • Export Citation
  • 16

    Pollock BEPhuong LKFoote RLStafford SLGorman DA: High-dose trigeminal neuralgia radiosurgery associated with increased risk of trigeminal nerve dysfunction. Neurosurgery 49:58642001

    • Search Google Scholar
    • Export Citation
  • 17

    Régis JMetellus PHayashi MRoussel PDonnet ABille-Turc F: Prospective controlled trial of gamma knife surgery for essential trigeminal neuralgia. J Neurosurg 104:9139242006

    • Search Google Scholar
    • Export Citation
  • 18

    Riesenburger RIHwang SWSchirmer CMZerris VWu JKMahn K: Outcomes following single-treatment Gamma Knife surgery for trigeminal neuralgia with a minimum 3-year follow-up. Clinical article. J Neurosurg 112:7667712010

    • Search Google Scholar
    • Export Citation
  • 19

    Rogers CLShetter AGFiedler JASmith KAHan PPSpeiser BL: Gamma knife radiosurgery for trigeminal neuralgia: the initial experience of The Barrow Neurological Institute. Int J Radiat Oncol Biol Phys 47:101310192000

    • Search Google Scholar
    • Export Citation
  • 20

    Rogers CLShetter AGPonce FAFiedler JASmith KASpeiser BL: Gamma knife radiosurgery for trigeminal neuralgia associated with multiple sclerosis. J Neurosurg 97:5 Suppl5295322002

    • Search Google Scholar
    • Export Citation
  • 21

    Sheehan JPan HCStroila MSteiner L: Gamma knife surgery for trigeminal neuralgia: outcomes and prognostic factors. J Neurosurg 102:4344412005

    • Search Google Scholar
    • Export Citation
  • 22

    Sheehan JPRay DKMonteith SYen CPLesnick JKersh R: Gamma Knife radiosurgery for trigeminal neuralgia: the impact of magnetic resonance imaging–detected vascular impingement of the affected nerve. Clinical article. J Neurosurg 113:53582010

    • Search Google Scholar
    • Export Citation
  • 23

    van der Kogel AJ: Radiation-induced damage in the central nervous system: an interpretation of target cell responses. Br J Cancer Suppl 7:2072171986

    • Search Google Scholar
    • Export Citation
  • 24

    Xue JGoldman HWGrimm JLaCouture TChen YHughes L: Dose-volume effects on brainstem dose tolerance in radiosurgery. Clinical article. J Neurosurg 117:Suppl1891962012

    • Search Google Scholar
    • Export Citation
  • 25

    Yen CPSchlesinger DSheehan JP: Gamma Knife® radiosurgery for trigeminal neuralgia. Expert Rev Med Devices 8:7097212011

  • 26

    Yousry IMoriggl BSchmid UDNaidich TPYousry TA: Trigeminal ganglion and its divisions: detailed anatomic MR imaging with contrast-enhanced 3D constructive interference in the steady state sequences. AJNR Am J Neuroradiol 26:112811352005

    • Search Google Scholar
    • Export Citation
TrendMD
Cited By
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 447 341 22
PDF Downloads 290 208 7
EPUB Downloads 0 0 0
PubMed
Google Scholar