Clinical outcomes after stereotactic radiosurgery for idiopathic trigeminal neuralgia

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Object. Stereotactic radiosurgery is an increasingly used and the least invasive surgical option for patients with trigeminal neuralgia. In this study, the authors investigate the clinical outcomes in patients treated with this procedure.

Methods. Independently acquired data from 220 patients with idiopathic trigeminal neuralgia who underwent gamma knife radiosurgery were reviewed. The median age was 70 years (range 26–92 years). Most patients had typical features of trigeminal neuralgia, although 16 (7.3%) described additional atypical features. One hundred thirty-five patients (61.4%) had previously undergone surgery and 80 (36.4%) had some degree of sensory disturbance related to the earlier surgery.

Patients were followed for a maximum of 6.5 years (median 2 years). Complete or partial relief was achieved in 85.6% of patients at 1 year. Complete pain relief was achieved in 64.9% of patients at 6 months, 70.3% at 1 year, and 75.4% at 33 months. Patients with an atypical pain component had a lower rate of pain relief (p = 0.025). Because of recurrences, only 55.8% of patients had complete or partial pain relief at 5 years. The absence of preoperative sensory disturbance (p = 0.02) or previous surgery (p = 0.01) correlated with an increased proportion of patients who experienced complete or partial pain relief over time. Thirty patients (13.6%) reported pain recurrence 2 to 58 months after initial relief (median 15.4 months). Only 17 patients (10.2% at 2 years) developed new or increased subjective facial paresthesia or numbness, including one who developed deafferentation pain.

Conclusions. Radiosurgery for idiopathic trigeminal neuralgia was safe and effective, and it provided benefit to a patient population with a high frequency of prior surgical intervention.

Article Information

Address reprint requests to: Douglas Kondziolka, M.D., Department of Neurological Surgery, Suite B-400, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, Pennsylvania 15213. email: kondziol@neuronet.pitt.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Actuarial plot showing the time to initial pain relief response after GKS for trigeminal neuralgia in 220 patients. Solid line represents the percentage of patients achieving greater than 50% pain relief; dotted line represents the percentage achieving complete pain relief.

  • View in gallery

    Graph showing a comparison of the time to achieve greater than 50% pain relief in patients with purely typical pain (solid line, 204 patients) and in those with partly atypical pain (dotted line, 16 patients). The rate of achieving at least 50% pain relief was faster in patients with typical trigeminal neuralgia compared with patients who had additional atypical features (p = 0.025, multivariate analysis).

  • View in gallery

    Actuarial plots showing the percentage of 220 patients achieving and maintaining greater than 50% pain relief (solid line) and complete pain relief (dotted line). The 5-year results do not reflect current practice because in most patients with 5-year follow up, radiation was delivered at a lower dose (60–65 Gy) than that presently used.

  • View in gallery

    Graph showing the percentage of patients achieving or maintaining complete pain relief who had no prior surgery (solid line, 85 patients) compared with those who had prior surgery (dotted line, 135 patients). A history of no prior surgery was the factor significantly associated with achieving and maintaining complete pain relief (p = 0.01, multivariate analysis).

  • View in gallery

    Graph showing the percentage of patients achieving or maintaining greater than 50% pain relief who had no preradiosurgery paresthesia (dysesthesia; solid line, 140 patients ) compared with those with preradiosurgery paresthesia (dotted lines, 80 patients). The absence of preradiosurgery paresthesia was significantly associated with achieving and maintaining greater than 50% pain relief (p = 0.024, multivariate analysis).

  • View in gallery

    Actuarial plot showing the population of patients with new or increased postradiosurgery paresthesias over time. The median time to developing paresthesias was 8 months (range 1–19 months). After 19 months, no patient developed new sensory symptoms.

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