Long-term outcome after gamma knife surgery for secondary trigeminal neuralgia

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  • 1 Departments of Stereotactic and Functional Neurosurgery, Neurosurgery, Otoneurosurgery, and Oncology—Radiology, Timone Hospital, Marseilles, France
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Object. This study was directed to evaluate the potential role of gamma knife surgery (GKS) in the treatment of secondary trigeminal neuralgia (TN). The authors have identified three anatomicoclinical types of secondary TN requiring different radiosurgical approaches.

Methods. Pain control was retrospectively analyzed in a population of patients harboring tumors of the middle or posterior fossa that involved the trigeminal nerve pathway. This series included 53 patients (39 women and 14 men) treated using GKS between July 1992 and June 1997. The median follow-up period was 55 months. Treatment strategies differed according to lesion type, topography, and size, as well as visibility of the fifth cranial nerve in the prepontine cistern. Three different treatment groups were established. When the primary goal was treatment of the lesion (Group IV, 46 patients) we obtained pain cessation in 79.5% of cases. In some patients in whom GKS was not indicated for treatment of the lesion, TN was treated by targeting the fifth nerve directly in the prepontine cistern if visible (Group II, three patients) or in the part of the lesion including this nerve if the nerve root could not be identified (Group III, four patients). No deaths and no radiosurgically induced adverse effects were observed, but in two cases there was slight hypesthesia (Group IV). The neuropathic component of the facial pain appeared to be poorly sensitive to radiosurgery. At the last follow-up examination, six patients (13.3%) exhibited recurrent pain, which was complete in four cases (8.8%) and partial in two (4.4%).

Conclusions. The results of GKS regarding facial pain control are very similar to those achieved by microsurgery according to series published in the literature. Nevertheless, the low rate of morbidity and the greater comfort afforded the patient render GKS safer and thus more attractive.

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Contributor Notes

Address reprint requests to: Jean Régis, M.D., Service de Neurochirurgie Fonctionnelle et Stéréotaxique, C.H.U. La Timone, 264, rue Saint-Pierre, 13385 Marseille Cedex 05, France.
  • 1.

    Al-Mefty O: Management of the cavernous sinus and carotid siphon. Otolaryngol Clin North Am 24:15231533, 1991 Al-Mefty O: Management of the cavernous sinus and carotid siphon. Otolaryngol Clin North Am 24:1523–1533, 1991

    • Search Google Scholar
    • Export Citation
  • 2.

    Al-Mefty O, & Smith RR: Surgery of tumors invading the cavernous sinus. Surg Neurol 30:370381, 1988 Al-Mefty O, Smith RR: Surgery of tumors invading the cavernous sinus. Surg Neurol 30:370–381, 1988

    • Search Google Scholar
    • Export Citation
  • 3.

    Anand VK, , House JR III, & Al-Mefty O: Management of benign neoplasms invading the cavernous sinus. Laryngoscope 101:557564, 1991 Anand VK, House JR III, Al-Mefty O: Management of benign neoplasms invading the cavernous sinus. Laryngoscope 101:557–564, 1991

    • Search Google Scholar
    • Export Citation
  • 4.

    Barker FG II, , Jannetta PJ, & Babu RP, et al: Long-term outcome after operation for trigeminal neuralgia in patients with posterior fossa tumors. J Neurosurg 84:818825, 1996 Barker FG II, Jannetta PJ, Babu RP, et al: Long-term outcome after operation for trigeminal neuralgia in patients with posterior fossa tumors. J Neurosurg 84:818–825, 1996

    • Search Google Scholar
    • Export Citation
  • 5.

    Bullitt E, , Tew JM, & Boyd J: Intracranial tumors in patients with facial pain. J Neurosurg 64:865871, 1986 Bullitt E, Tew JM, Boyd J: Intracranial tumors in patients with facial pain. J Neurosurg 64:865–871, 1986

    • Search Google Scholar
    • Export Citation
  • 6.

    Cheng TM, , Cascino TL, & Onofrio BM: Comprehensive study of diagnosis and treatment of trigeminal neuralgia secondary to tumors. Neurology 43:22982302, 1993 Cheng TM, Cascino TL, Onofrio BM: Comprehensive study of diagnosis and treatment of trigeminal neuralgia secondary to tumors. Neurology 43:2298–2302, 1993

    • Search Google Scholar
    • Export Citation
  • 7.

    Delfini R, , Innocenzi G, & Ciappetta P, et al: Meningiomas of Meckel's cave. Neurosurgery 31:10001007, 1992 Delfini R, Innocenzi G, Ciappetta P, et al: Meningiomas of Meckel's cave. Neurosurgery 31:1000–1007, 1992

    • Search Google Scholar
    • Export Citation
  • 8.

    Flickinger JC, , Kondziolka D, & Pollock BE, et al: Evolution in technique for vestibular schwannoma radiosurgery and effect on outcome. Int J Radiat Oncol Biol Phys 36:275280, 1996 Flickinger JC, Kondziolka D, Pollock BE, et al: Evolution in technique for vestibular schwannoma radiosurgery and effect on outcome. Int J Radiat Oncol Biol Phys 36:275–280, 1996

    • Search Google Scholar
    • Export Citation
  • 9.

    Gardner WJ: Trigeminal neuralgia. Clin Neurosurg 15:156, 1968 Gardner WJ: Trigeminal neuralgia. Clin Neurosurg 15:1–56, 1968

  • 10.

    Huang CF, , Kondziolka D, & Flickinger JC, et al: Stereotactic radiosurgery for trigeminal schwannomas. Neurosurgery 45:1116, 1999 Huang CF, Kondziolka D, Flickinger JC, et al: Stereotactic radiosurgery for trigeminal schwannomas. Neurosurgery 45:11–16, 1999

    • Search Google Scholar
    • Export Citation
  • 11.

    Hudgins WR, , Barker JL, & Schwartz DE, et al: Gamma knife treatment of 100 consecutive meningiomas. Stereotact Funct Neurosurg 66 (Suppl 1):121128, 1996 Hudgins WR, Barker JL, Schwartz DE, et al: Gamma knife treatment of 100 consecutive meningiomas. Stereotact Funct Neurosurg 66 (Suppl 1):121–128, 1996

    • Search Google Scholar
    • Export Citation
  • 12.

    Kondziolka D: Functional radiosurgery. Neurosurgery 44:1222, 1999 Kondziolka D: Functional radiosurgery. Neurosurgery 44:12–22, 1999

    • Search Google Scholar
    • Export Citation
  • 13.

    Kondziolka D, & Lunsford LD: Radiosurgery of meningiomas. Neurosurg Clin North Am 3:219230, 1992 Kondziolka D, Lunsford LD: Radiosurgery of meningiomas. Neurosurg Clin North Am 3:219–230, 1992

    • Search Google Scholar
    • Export Citation
  • 14.

    Kondziolka D, , Lunsford LD, & Coffey RJ, et al: Gamma knife radiosurgery of meningiomas. Stereotact Funct Neurosurg 57:1121, 1991 Kondziolka D, Lunsford LD, Coffey RJ, et al: Gamma knife radiosurgery of meningiomas. Stereotact Funct Neurosurg 57:11–21, 1991

    • Search Google Scholar
    • Export Citation
  • 15.

    Kondziolka D, , Lunsford LD, & Flickinger JC: Gamma knife radiosurgery as the first surgery for trigeminal neuralgia. Stereotact Funct Neurosurg 70 (Suppl 1):187191, 1998 Kondziolka D, Lunsford LD, Flickinger JC: Gamma knife radiosurgery as the first surgery for trigeminal neuralgia. Stereotact Funct Neurosurg 70 (Suppl 1):187–191, 1998

    • Search Google Scholar
    • Export Citation
  • 16.

    Kondziolka D, , Lunsford LD, & Flickinger JC, et al: Stereotactic radiosurgery for trigeminal neuralgia: a multiinstitutional study using the gamma unit. J Neurosurg 84:940945, 1996 Kondziolka D, Lunsford LD, Flickinger JC, et al: Stereotactic radiosurgery for trigeminal neuralgia: a multiinstitutional study using the gamma unit. J Neurosurg 84:940–945, 1996

    • Search Google Scholar
    • Export Citation
  • 17.

    Kondziolka D, , Lunsford LD, & McLaughlin MR, et al: Long-term outcomes after radiosurgery for acoustic neuromas. N Engl J Med 339:14261433, 1998 Kondziolka D, Lunsford LD, McLaughlin MR, et al: Long-term outcomes after radiosurgery for acoustic neuromas. N Engl J Med 339:1426–1433, 1998

    • Search Google Scholar
    • Export Citation
  • 18.

    Kondziolka D, , Perez B, & Flickinger JC, et al: Gamma knife radiosurgery for trigeminal neuralgia. Results and expectations. Arch Neurol 55:15241529, 1998 Kondziolka D, Perez B, Flickinger JC, et al: Gamma knife radiosurgery for trigeminal neuralgia. Results and expectations. Arch Neurol 55:1524–1529, 1998

    • Search Google Scholar
    • Export Citation
  • 19.

    Leksell L: Stereotaxic radiosurgery in trigeminal neuralgia. Acta Chir Scand 137:311314, 1971 Leksell L: Stereotaxic radiosurgery in trigeminal neuralgia. Acta Chir Scand 137:311–314, 1971

    • Search Google Scholar
    • Export Citation
  • 20.

    Leksell L, , Lindquist C, & Adler JR, et al: A new fixation device for the Leksell stereotaxic system. Technical note. J Neurosurg 66:626629, 1987 Leksell L, Lindquist C, Adler JR, et al: A new fixation device for the Leksell stereotaxic system. Technical note. J Neurosurg 66:626–629, 1987

    • Search Google Scholar
    • Export Citation
  • 21.

    Lindquist C, , Kihlstrom L, & Hellstrand E: Functional neurosurgery—a future for the gamma knife? Stereotact Funct Neurosurg 57:7281, 1991 Lindquist C, Kihlstrom L, Hellstrand E: Functional neurosurgery—a future for the gamma knife? Stereotact Funct Neurosurg 57:72–81, 1991

    • Search Google Scholar
    • Export Citation
  • 22.

    Lunsford LD, , Kondziolka DS, & Flickinger JC: Radiosurgery of tumors of the cerebellopontine angle. Clin Neurosurg 41:168184, 1994 Lunsford LD, Kondziolka DS, Flickinger JC: Radiosurgery of tumors of the cerebellopontine angle. Clin Neurosurg 41: 168–184, 1994

    • Search Google Scholar
    • Export Citation
  • 23.

    McCormick PC, , Bello JA, & Post KD: Trigeminal schwannoma. Surgical series of 14 cases with review of the literature. J Neurosurg 69:850860, 1988 McCormick PC, Bello JA, Post KD: Trigeminal schwannoma. Surgical series of 14 cases with review of the literature. J Neurosurg 69:850–860, 1988

    • Search Google Scholar
    • Export Citation
  • 24.

    Muthukumar N, , Kondziolka D, & Lunsford LD, et al: Stereotactic radiosurgery for tentorial meningiomas. Acta Neurochir 140:315321, 1998 Muthukumar N, Kondziolka D, Lunsford LD, et al: Stereotactic radiosurgery for tentorial meningiomas. Acta Neurochir 140: 315–321, 1998

    • Search Google Scholar
    • Export Citation
  • 25.

    Nijensohn DE, , Araujo JC, & MacCarty CS: Meningiomas of Meckel's cave. J Neurosurg 43:197202, 1975 Nijensohn DE, Araujo JC, MacCarty CS: Meningiomas of Meckel's cave. J Neurosurg 43:197–202, 1975

    • Search Google Scholar
    • Export Citation
  • 26.

    Noren G: Long-term complications following gamma knife radiosurgery of vestibular schwannomas. Stereotact Funct Neurosurg 70 (Suppl 1):6573, 1998 Noren G: Long-term complications following gamma knife radiosurgery of vestibular schwannomas. Stereotact Funct Neurosurg 70 (Suppl 1):65–73, 1998

    • Search Google Scholar
    • Export Citation
  • 27.

    Ogleznev KY, , Grigoryan YA, & Slavin KV: Parapontine epidermoid tumors presenting as trigeminal neuralgias: anatomical findings and operative results. Acta Neurochir 110:116119, 1991 Ogleznev KY, Grigoryan YA, Slavin KV: Parapontine epidermoid tumors presenting as trigeminal neuralgias: anatomical findings and operative results. Acta Neurochir 110:116–119, 1991

    • Search Google Scholar
    • Export Citation
  • 28.

    Osborn DA, & Winston P: Carcinoma of the paranasal sinuses. J Laryngol 75:387405, 1961 Osborn DA, Winston P: Carcinoma of the paranasal sinuses. J Laryngol 75:387–405, 1961

    • Search Google Scholar
    • Export Citation
  • 29.

    Pendl G, , Schrottner O, & Eustacchio S, et al: Cavernous sinus meningiomas—what is the strategy: upfront or adjuvant gamma knife surgery? Stereotact Funct Neurosurg 70 (Suppl 1):3340, 1998 Pendl G, Schrottner O, Eustacchio S, et al: Cavernous sinus meningiomas—what is the strategy: upfront or adjuvant gamma knife surgery? Stereotact Funct Neurosurg 70 (Suppl 1):33–40, 1998

    • Search Google Scholar
    • Export Citation
  • 30.

    Pollack IF, , Sekhar LN, & Jannetta PJ, et al: Neurilemomas of the trigeminal nerve. J Neurosurg 70:737745, 1989 Pollack IF, Sekhar LN, Jannetta PJ, et al: Neurilemomas of the trigeminal nerve. J Neurosurg 70:737–745, 1989

    • Search Google Scholar
    • Export Citation
  • 31.

    Pollock BE, , Gorman DA, & Schomberg PJ, et al: The Mayo Clinic gamma knife experience: indications and initial results. Mayo Clin Proc 74:513, 1999 Pollock BE, Gorman DA, Schomberg PJ, et al: The Mayo Clinic gamma knife experience: indications and initial results. Mayo Clin Proc 74:5–13, 1999

    • Search Google Scholar
    • Export Citation
  • 32.

    Pollock BE, , Lunsford LD, & Kondziolka D, et al: Outcome analysis of acoustic neuroma management: a comparison of microsurgery and stereotactic radiosurgery. Neurosurgery 36:215229, 1995 Pollock BE, Lunsford LD, Kondziolka D, et al: Outcome analysis of acoustic neuroma management: a comparison of microsurgery and stereotactic radiosurgery. Neurosurgery 36: 215–229, 1995

    • Search Google Scholar
    • Export Citation
  • 33.

    Prasad D, , Steiner M, & Steiner L: Gamma surgery for vestibular schwannoma. J Neurosurg 92:745759, 2000 Prasad D, Steiner M, Steiner L: Gamma surgery for vestibular schwannoma. J Neurosurg 92:745–759, 2000

    • Search Google Scholar
    • Export Citation
  • 34.

    Puca A, , Meglio M, & Tamburrini G, et al: Trigeminal involvement in intracranial tumours. Anatomical and clinical observations on 73 patients. Acta Neurochir 125:4751, 1993 Puca A, Meglio M, Tamburrini G, et al: Trigeminal involvement in intracranial tumours. Anatomical and clinical observations on 73 patients. Acta Neurochir 125:47–51, 1993

    • Search Google Scholar
    • Export Citation
  • 35.

    Rand RW: Leksell gamma knife treatment of tic douloureux. Neurosurg Clin North Am 8:7578, 1997 Rand RW: Leksell gamma knife treatment of tic douloureux. Neurosurg Clin North Am 8:75–78, 1997

    • Search Google Scholar
    • Export Citation
  • 36.

    Rand RW, , Jacques DB, & Melbye RW, et al: Leksell gamma knife treatment of tic douloureux. Stereotact Funct Neurosurg 61 (Suppl 1):93102, 1993 Rand RW, Jacques DB, Melbye RW, et al: Leksell gamma knife treatment of tic douloureux. Stereotact Funct Neurosurg 61 (Suppl 1):93–102, 1993

    • Search Google Scholar
    • Export Citation
  • 37.

    Regis J, , Bartolomei F, & Metellus P, et al: Radiosurgery for trigeminal neuralgia and epilepsy. Neurosurg Clin North Am 10:359377, 1999 Regis J, Bartolomei F, Metellus P, et al: Radiosurgery for trigeminal neuralgia and epilepsy. Neurosurg Clin North Am 10: 359–377, 1999

    • Search Google Scholar
    • Export Citation
  • 38.

    Regis J, , Manera L, & Dufour H, et al: Effect of the gamma knife on trigeminal neuralgia. Stereotact Funct Neurosurg 64 (Suppl 1):182192, 1995 Regis J, Manera L, Dufour H, et al: Effect of the gamma knife on trigeminal neuralgia. Stereotact Funct Neurosurg 64 (Suppl 1):182–192, 1995

    • Search Google Scholar
    • Export Citation
  • 39.

    Regis J, , Metellus P, & Lazorthes Y, et al: Effect of gamma knife on secondary trigeminal neuralgia. Stereotact Funct Neurosurg 70 (Suppl 1):210217, 1998 Regis J, Metellus P, Lazorthes Y, et al: Effect of gamma knife on secondary trigeminal neuralgia. Stereotact Funct Neurosurg 70 (Suppl 1):210–217, 1998

    • Search Google Scholar
    • Export Citation
  • 40.

    Regis J, & Pellet W: Radiochirurgie ou microchirurgie des schwannomes vestibulaires? Cancer Radiother 2:191201, 1998 Regis J, Pellet W: Radiochirurgie ou microchirurgie des schwannomes vestibulaires? Cancer Radiother 2:191–201, 1998

    • Search Google Scholar
    • Export Citation
  • 41.

    Revilla AG: Tic douloureux and its relationship to tumors of the posterior fossa. Analysis of twenty-four cases. J Neurosurg 4:233239, 1947 Revilla AG: Tic douloureux and its relationship to tumors of the posterior fossa. Analysis of twenty-four cases. J Neurosurg 4: 233–239, 1947

    • Search Google Scholar
    • Export Citation
  • 42.

    Ruge D, , Brochner R, & Davis L: A study of the treatment of 637 patients with trigeminal neuralgia. J Neurosurg 15:528536, 1958 Ruge D, Brochner R, Davis L: A study of the treatment of 637 patients with trigeminal neuralgia. J Neurosurg 15:528–536, 1958

    • Search Google Scholar
    • Export Citation
  • 43.

    Salem LE, , Zaharia M, & Travezan R: Carcinoma of the paranasal sinuses. Am J Surg 106:826830, 1963 Salem LE, Zaharia M, Travezan R: Carcinoma of the paranasal sinuses. Am J Surg 106:826–830, 1963

    • Search Google Scholar
    • Export Citation
  • 44.

    Sekhar LN, , Lanzino G, & Sen CN, et al: Reconstruction of the third through sixth cranial nerves during cavernous sinus surgery. J Neurosurg 76:935943, 1992 Sekhar LN, Lanzino G, Sen CN, et al: Reconstruction of the third through sixth cranial nerves during cavernous sinus surgery. J Neurosurg 76:935–943, 1992

    • Search Google Scholar
    • Export Citation
  • 45.

    Sekhar LN, , Linskey ME, & Sen CN, et al: Surgical management of lesions within the cavernous sinus. Clin Neurosurg 37:440489, 1991 Sekhar LN, Linskey ME, Sen CN, et al: Surgical management of lesions within the cavernous sinus. Clin Neurosurg 37: 440–489, 1991

    • Search Google Scholar
    • Export Citation
  • 46.

    Sekhar LN, & Møller AR: Operative management of tumors involving the cavernous sinus. J Neurosurg 64:879889, 1986 Sekhar LN, Møller AR: Operative management of tumors involving the cavernous sinus. J Neurosurg 64:879–889, 1986

    • Search Google Scholar
    • Export Citation
  • 47.

    Sekhar LN, , Patel S, & Cusimano M, et al: Surgical treatment of meningiomas involving the cavernous sinus: evolving ideas based on a ten year experience. Acta Neurochir Suppl 65:5862, 1996 Sekhar LN, Patel S, Cusimano M, et al: Surgical treatment of meningiomas involving the cavernous sinus: evolving ideas based on a ten year experience. Acta Neurochir Suppl 65: 58–62, 1996

    • Search Google Scholar
    • Export Citation
  • 48.

    Sekhar LN, , Pomeranz S, & Sen CN: Management of tumours involving the cavernous sinus. Acta Neurochir Suppl 53:101112, 1991 Sekhar LN, Pomeranz S, Sen CN: Management of tumours involving the cavernous sinus. Acta Neurochir Suppl 53: 101–112, 1991

    • Search Google Scholar
    • Export Citation
  • 49.

    Sekhar LN, , Sen CN, & Jho HD, et al: Surgical treatment of intracavernous neoplasms: a four-year experience. Neurosurgery 24:1830, 1989 Sekhar LN, Sen CN, Jho HD, et al: Surgical treatment of intracavernous neoplasms: a four-year experience. Neurosurgery 24:18–30, 1989

    • Search Google Scholar
    • Export Citation
  • 50.

    Sen C, & Sekhar LN: Direct vein graft reconstruction of the cavernous, petrous, and upper cervical internal carotid artery: lessons learned from 30 cases. Neurosurgery 30:732743, 1992 Sen C, Sekhar LN: Direct vein graft reconstruction of the cavernous, petrous, and upper cervical internal carotid artery: lessons learned from 30 cases. Neurosurgery 30:732–743, 1992

    • Search Google Scholar
    • Export Citation
  • 51.

    Sepehrnia A, , Samii M, & Tatagiba M: Management of intracavernous tumours: an 11-year experience. Acta Neurochir Suppl 53:122126, 1991 Sepehrnia A, Samii M, Tatagiba M: Management of intracavernous tumours: an 11-year experience. Acta Neurochir Suppl 53:122–126, 1991

    • Search Google Scholar
    • Export Citation
  • 52.

    Shafron DH, , Friedman WA, & Buatti JM, et al: Linac radiosurgery for benign meningiomas. Int J Radiat Oncol Biol Phys 43:321327, 1999 Shafron DH, Friedman WA, Buatti JM, et al: Linac radiosurgery for benign meningiomas. Int J Radiat Oncol Biol Phys 43:321–327, 1999

    • Search Google Scholar
    • Export Citation
  • 53.

    Subach BR, , Lunsford LD, & Kondziolka D, et al: Management of petroclival meningiomas by stereotactic radiosurgery. Neurosurgery 42:437445, 1998 Subach BR, Lunsford LD, Kondziolka D, et al: Management of petroclival meningiomas by stereotactic radiosurgery. Neurosurgery 42:437–445, 1998

    • Search Google Scholar
    • Export Citation
  • 54.

    Urgosik D, , Vymazal J, & Vladyka V, et al: Gamma knife treatment of trigeminal neuralgia: clinical and electrophysiological study. Stereotact Funct Neurosurg 70 (Suppl 1):200209, 1998 Urgosik D, Vymazal J, Vladyka V, et al: Gamma knife treatment of trigeminal neuralgia: clinical and electrophysiological study. Stereotact Funct Neurosurg 70 (Suppl 1):200–209, 1998

    • Search Google Scholar
    • Export Citation
  • 55.

    Ver Brugghenn A: Paragasserian tumours. J Neurosurg 9:451460, 1952 Ver Brugghenn A: Paragasserian tumours. J Neurosurg 9: 451–460, 1952

    • Search Google Scholar
    • Export Citation
  • 56.

    Young RF, , Vermeulen SS, & Grimm P, et al: Gamma knife radiosurgery for treatment of trigeminal neuralgia. Idiopathic and tumor related. Neurology 48:608614, 1997 Young RF, Vermeulen SS, Grimm P, et al: Gamma knife radiosurgery for treatment of trigeminal neuralgia. Idiopathic and tumor related. Neurology 48:608–614, 1997

    • Search Google Scholar
    • Export Citation

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