Stereotactic radiosurgery for idiopathic trigeminal neuralgia

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Object. Each year a greater number of patients with trigeminal neuralgia (TN) undergo radiosurgery, including a large number of patients who are candidates for microvascular decompression (MVD).

Methods. The case characteristics and outcomes of 117 consecutive patients who underwent radiosurgery were retrieved from a prospectively maintained database. The mean patient age was 67.8 years; and the majority (58%) of patients had undergone surgery previously. The dependent variable for all analyses of facial pain was complete pain relief without medication (excellent outcome). Median follow-up duration was 26 months (range 1–48 months). The actuarial rate of achieving and maintaining an excellent outcome was 57% and 55% at 1 and 3 years, respectively, after radiosurgery. A greater percentage of patients who had not previously undergone surgery achieved and maintained excellent outcomes (67% at 1 and 3 years) than that of patients who had undergone prior surgery (51% and 47% at 1 and 3 years, respectively; relative risk [RR] = 1.77, 95% confidence interval [CI] 1.01–3.13, p = 0.04). New persistent trigeminal dysfunction was noted in 43 patients (37%). Tolerable numbness or paresthesias occurred in 29 patients (25%), whereas bothersome dysesthesias developed in 14 patients (12%). Only a radiation dose of 90 Gy correlated with new trigeminal deficits or dysesthesias (RR = 3.10, 95% CI 1.64–5.81, p < 0.001). Excellent outcomes in patients with new trigeminal dysfunction were achieved and maintained at rates of 76% and 74% at 1 and 3 years, respectively, after radiosurgery, compared with respective rates of 46% and 42% in patients who did not experience postradiosurgery trigeminal dysfunction (RR = 4.53, 95% CI 2.03–9.95, p < 0.01).

Conclusions. Radiosurgical treatment provides complete pain relief for the majority of patients with idiopathic TN. There is a strong correlation between the development of new facial sensory loss and achievement and maintenance of pain relief after this procedure. Because the long-term results of radiosurgery still remain unknown, MVD should continue to be the primary operation for medically fit patients with TN.

Article Information

Address reprint requests to: Bruce E. Pollock, M.D., Department of Neurological Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905. email: pollock.bruce@mayo.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    Actuarial plot showing the percentage of 117 patients with TN in whom excellent outcomes (no pain and no medications) were achieved and maintained after stereotactic radiosurgery.

  • View in gallery

    Actuarial plots showing the percentages of patients in whom an excellent outcome (no pain and no medications) was achieved and maintained among those who did not undergo prior surgery (solid line, 49 patients) and those who did (dotted line, 68 patients; p = 0.04).

  • View in gallery

    Actuarial plots showing the percentages of patients in whom excellent outcomes (no pain and no medications) were achieved and maintained among those with postradiosurgery trigeminal dysfunction (solid line, 43 patients) and those without (dotted line, 74 patients; p < 0.01).

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