Radiosurgery for multiple sclerosis–related trigeminal neuralgia: retrospective review of long-term outcomes

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OBJECTIVE

The objective of this study was to assess long-term outcomes of facial pain and numbness after radiosurgery for multiple sclerosis (MS)–related trigeminal neuralgia (MS-TN).

METHODS

The authors conducted a retrospective review of their Gamma Knife radiosurgeries (GKRSs) to identify all patients treated for MS-TN (1998–2014) with at least 3 years of follow-up. Treatment and clinical data were obtained via chart review and mailed or telephone surveys. Pain control was defined as a facial pain score of I–IIIb on the Barrow Neurological Institute (BNI) Facial Pain Intensity Scale. Kaplan-Meier analysis was performed to determine the rates of pain control after index and first salvage GKRS procedures. Patients could have had more than 1 salvage procedure. Pain control rates were based on the number of patients at risk during follow-up.

RESULTS

Of the 50 living patients who underwent GKRS, 42 responded to surveys (31 women [74%], median age 59 years, range 32–76 years). During the initial GKRS, the trigeminal nerve root entry zone was targeted with a single isocenter, using a 4-mm collimator with the 90% isodose line completely covering the trigeminal nerve and the 50% isodose line abutting the surface of the brainstem. The median maximum radiation dose was 85 Gy (range 50–85 Gy). The median follow-up period was 78 months (range 36–226 months). The rate of pain control after the index GKRS (n = 42) was 62%, 29%, 22%, and 13% at 1, 3, 5, and 7 years, respectively. Twenty-eight patients (67%) underwent salvage treatment, including 25 (60%) whose first salvage treatment was GKRS. The rate of pain control after the first salvage GKRS (n = 25) was 84%, 50%, 44%, and 17% at 1, 3, 5, and 7 years, respectively. The rate of pain control after the index GKRS with or without 1 salvage GKRS (n = 33) was 92%, 72%, 52%, 46%, and 17% at 1, 3, 5, 7, and 10 years, respectively. At last follow-up, 9 (21%) of the 42 patients had BNI grade I facial pain, 35 (83%) had achieved pain control, and 4 (10%) had BNI grade IV facial numbness (very bothersome in daily life).

CONCLUSIONS

Index GKRS offers good short-term pain control for MS-TN, but long-term pain control is uncommon. If the index GKRS fails, salvage GKRS appears to offer beneficial pain control with low rates of bothersome facial numbness.

ABBREVIATIONS BNI = Barrow Neurological Institute; GKRS = Gamma Knife radiosurgery; mRS = modified Rankin Scale; MS = multiple sclerosis; MS-TN = MS-related trigeminal neuralgia; MVD = microvascular decompression; TN = trigeminal neuralgia.
Article Information

Contributor Notes

Correspondence Andrew G. Shetter: Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ. neuropub@barrowneuro.org.INCLUDE WHEN CITING Published online November 30, 2018; DOI: 10.3171/2018.5.JNS173194.Disclosures Dr. Little is a shareholder in Kogent Surgical.
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References
  • 1

    Broggi GFerroli PFranzini ANazzi VFarina LLa Mantia L: Operative findings and outcomes of microvascular decompression for trigeminal neuralgia in 35 patients affected by multiple sclerosis. Neurosurgery 55:8308392004

    • Search Google Scholar
    • Export Citation
  • 2

    Eller JLRaslan AMBurchiel KJ: Trigeminal neuralgia: definition and classification. Neurosurg Focus 18(5):E32005

  • 3

    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
  • 4

    Hooge JPRedekop WK: Trigeminal neuralgia in multiple sclerosis. Neurology 45:129412961995

  • 5

    Huang ETeh BSZeck OWoo SYLu HHChiu JK: Gamma knife radiosurgery for treatment of trigeminal neuralgia in multiple sclerosis patients. Stereotact Funct Neurosurg 79:44502002

    • Search Google Scholar
    • Export Citation
  • 6

    Kanpolat YBerk CSavas ABekar A: Percutaneous controlled radiofrequency rhizotomy in the management of patients with trigeminal neuralgia due to multiple sclerosis. Acta Neurochir (Wien) 142:6856902000

    • Search Google Scholar
    • Export Citation
  • 7

    Kondziolka DLunsford LDBissonette DJ: Long-term results after glycerol rhizotomy for multiple sclerosis-related trigeminal neuralgia. Can J Neurol Sci 21:1371401994

    • Search Google Scholar
    • Export Citation
  • 8

    Little ASShetter AGShetter MEBay CRogers CL: Long-term pain response and quality of life in patients with typical trigeminal neuralgia treated with gamma knife stereotactic radiosurgery. Neurosurgery 63:9159242008

    • Search Google Scholar
    • Export Citation
  • 9

    Mathieu DEffendi KBlanchard JSéguin M: Comparative study of Gamma Knife surgery and percutaneous retrogasserian glycerol rhizotomy for trigeminal neuralgia in patients with multiple sclerosis. J Neurosurg 117 Suppl:1751802012

    • Search Google Scholar
    • Export Citation
  • 10

    Park KJKondziolka DBerkowitz OKano HNovotny J JrNiranjan A: Repeat gamma knife radiosurgery for trigeminal neuralgia. Neurosurgery 70:2953052012

    • Search Google Scholar
    • Export Citation
  • 11

    Resnick DKJannetta PJLunsford LDBissonette DJ: Microvascular decompression for trigeminal neuralgia in patients with multiple sclerosis. Surg Neurol 46:3583621996

    • Search Google Scholar
    • Export Citation
  • 12

    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
  • 13

    Rogers CLShetter AGPonce FAFiedler JASmith KASpeiser BL: Gamma knife radiosurgery for trigeminal neuralgia associated with multiple sclerosis. J Neurosurg 97 (5 Suppl):5295322002

    • Search Google Scholar
    • Export Citation
  • 14

    Tuleasca CCarron RResseguier NDonnet ARoussel PGaudart J: Multiple sclerosis-related trigeminal neuralgia: a prospective series of 43 patients treated with gamma knife surgery with more than one year of follow-up. Stereotact Funct Neurosurg 92:2032102014

    • Search Google Scholar
    • Export Citation
  • 15

    Tuleasca CCarron RResseguier NDonnet ARoussel PGaudart J: Repeat Gamma Knife surgery for recurrent trigeminal neuralgia: long-term outcomes and systematic review. J Neurosurg 121 Suppl:2102212014

    • Search Google Scholar
    • Export Citation
  • 16

    Weller MMarshall KLovato JFBourland JDdeGuzman AFMunley MT: Single-institution retrospective series of gamma knife radiosurgery in the treatment of multiple sclerosis-related trigeminal neuralgia: factors that predict efficacy. Stereotact Funct Neurosurg 92:53582014

    • Search Google Scholar
    • Export Citation
  • 17

    Xu ZSchlesinger DMoldovan KPrzybylowski CSun XLee CC: Impact of target location on the response of trigeminal neuralgia to stereotactic radiosurgery. J Neurosurg 120:7167242014

    • Search Google Scholar
    • Export Citation
  • 18

    Zorro OLobato-Polo JKano HFlickinger JCLunsford LDKondziolka D: Gamma knife radiosurgery for multiple sclerosis-related trigeminal neuralgia. Neurology 73:114911542009

    • Search Google Scholar
    • Export Citation
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