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Microvascular decompression after gamma knife surgery for trigeminal neuralgia: intraoperative findings and treatment outcomes

Andrew G. Shetter, Joseph M. Zabramski, and Burton L. Speiser

control and complications do not appear to be compromised. Patients who elect the less invasive and lower morbidity option of GKS can be assured that MVD remains a viable alternative at a later date if further surgery is necessary. References 1. Barker FG , Jannetta PJ , Bissonette DJ , et al : The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334 : 1077 – 1083 , 1996 Barker FG, Jannetta PJ, Bissonette DJ, et al: The long-term outcome of microvascular decompression for

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Prospective controlled trial of gamma knife surgery for essential trigeminal neuralgia

Jean Régis, Philippe Metellus, Motohiro Hayashi, Philippe Roussel, Anne Donnet, and Françoise Bille-Turc

trigeminal nerve. The pain may be effectively treated by a series of percutaneous techniques (thermocoagulation, microcompression, glycerol injection) that produce a partial lesion of the trigeminal nerve. 7 , 19 , 27 , 43 , 45 , 59 , 60 , 71 The concept of stereotactic radiosurgery was first introduced by Lars Leksell who, in 1951, began performing clinical radiosurgery with a stereotactic x-ray beam in patients with essential trigeminal neuralgia. 28–30 The use of GKS with 201-source cobalt-60 was adopted in 1968. However, due to the efficacy of this tool for the

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Management outcomes of peripontine arteriovenous malformation patients presenting with trigeminal neuralgia

Wuyang Yang, Shahab Aldin Sattari, James Feghali, Alice Hung, Yuxi Chen, Risheng Xu, Chetan Bettegowda, Michael Lim, and Judy Huang

database was queried for non–hereditary hemorrhagic telangiectasia (HHT), single bAVM in a pontine, cistern, brainstem, trigeminal nerve, or tentorial location to indicate peripontine locations. Patients with complete data were included in a search for trigeminal neuralgia or facial pain as the presenting symptom, with TN being ipsilateral to the bAVM. All remaining patients with peripontine bAVMs were included in this study, and patients were grouped based on the presence of TN. Patients with incomplete data or follow-up were excluded. Variable Definition

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Trigeminal neuralgia and neuropathy in large sporadic vestibular schwannomas

Brian A. Neff, Matthew L. Carlson, Megan M. O'Byrne, Jamie J. Van Gompel, Colin L. W. Driscoll, and Michael J. Link

T umor-related facial pain accounts for approximately 1%–13% of patients with clinical trigeminal neuralgia (TN) symptoms. 4 , 23 Many of these cases are caused by trigeminal schwannomas or petroclival meningiomas, but trigeminal nerve symptoms are also seen with posterior fossa cerebellopontine angle (CPA) tumors such as vestibular schwannomas (VSs). VS-related TN and trigeminal neuropathy are thought to occur from direct tumor pressure on the trigeminal nerve, which causes demyelination of the somatosensory and pain fibers or, less likely, from a tumor

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Gamma knife surgery for trigeminal neuralgia: improved initial response with two isocenters and increasing dose

Tracy E. Alpert, Chung T. Chung, Lisa T. Mitchell, Charles J. Hodge, Craig T. Montgomery, Jeffrey A. Bogart, Daniel Y-J. Kim, Danel A. Bassano, and Seung S. Hahn

55% of patients. 12, 15 Trigeminal neuralgia is one of the most rapidly evolving indications for stereotactic radiosurgery In an attempt to further improve pain relief, there has been a tendency to increase the maximum dose delivered. A dose of 90 Gy has been reported to be safe and effective. 13 Response rates are improved with doses greater than 70 Gy, although dose—response comparisons at higher levels are limited. 7 The volume of the trigeminal nerve included in the treatment volume was also studied in an attempt to improve pain relief further. The results

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Radiosurgery for trigeminal neuralgia: is sensory disturbance required for pain relief?

Bruce E. Pollock

typical trigeminal neuralgia . Neurosurgery 40 : 39 – 45 , 1997 3 Barker FG II , Jannetta PJ , Bissonette DJ , Larkins MV , Jho HD : The long-term outcome of microvascular decompression for trigeminal neuralgia . N Engl J Med 334 : 1077 – 1083 , 1996 10.1056/NEJM199604253341701 4 Bergenheim AT , Shamsgovara P , Ridderheim PA : Microvascular decompression for trigeminal neuralgia: no relation between sensory disturbance and outcome . Stereotact Funct Neurosurg 68 : 200 – 206 , 1997 10.1159/000099924 5 Blomstedt PC , Bergenheim

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A dosimetric comparison between Gamma Knife and CyberKnife treatment plans for trigeminal neuralgia

Clinical article

Martina Descovich, Penny K. Sneed, Nicholas M. Barbaro, Michael W. McDermott, Cynthia F. Chuang, Igor J. Barani, Jean L. Nakamura, and Lijun Ma

T rigeminal neuralgia is a disorder of the CN V, which causes episodes of severe facial pain. Treatment options for patients with trigeminal neuralgia include pharmacological therapy with a variety of anticonvulsant drugs, surgery (microvascular decompression), percutaneous surgical procedures (balloon compression, glycerol rhizotomy, and radiofrequency rhizotomy), and SRS. Stereotactic radiosurgery has been adopted in the management of trigeminal neuralgia since 1951, when Lars Leksell treated the first patient by irradiating the trigeminal ganglion with an

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Comparison of percutaneous balloon compression and glycerol rhizotomy for the treatment of trigeminal neuralgia

Clinical article

Konstantinos Kouzounias, Göran Lind, Gastón Schechtmann, Jaleh Winter, and Bengt Linderoth

for trigeminal neuralgia . Neurosurgery 36 : 303 – 310 , 1995 2 Bergenheim AT , Hariz MI , Laitinen LV : Retrogasserian glycerol rhizotomy and its selectivity in the treatment of trigeminal neuralgia . Acta Neurochir Suppl (Wien) 58 : 174 – 177 , 1993 3 Bergenheim AT , Linderoth B : Diplopia after balloon compression of retrogasserian ganglion rootlets for trigeminal neuralgia: technical case report . Neurosurgery 62 : E533 – E534 , 2008 4 Blomstedt PC , Bergenheim AT : Technical difficulties and perioperative complications of

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Microsurgical outcomes after failed repeated Gamma Knife surgery for refractory trigeminal neuralgia

Chuan-Fu Huang, Jim-Chao Chuang, Hsien-Tang Tu, and Ming-Chih Chou

/P/P −/− −/− 16 8 1 57, F 80/50/130 3/3 P/P/E −/+ −/+(vein) 12 * G = good; E = excellent; P = poor. References 1 Barker FG , Jannetta PJ , Bissonette DJ , Larkins MV , Jho HD : The long term outcome of microvascular decompression for trigeminal neuralgia . N Engl J Med 334 : 1077 – 1083 , 1996 10.1056/NEJM199604253341701 2 Brandt-Zawadzki M , Anderson M , DeArmond SJ : Radiation induced large intracranial vessel occlusive vasculopathy . Am J Roentgenol 134 : 51 – 55 , 1980 10.2214/ajr.134.1.51 3 Cho DY , Chang CGS , Wang YC , Wang FH

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Relation of hypesthesia to the outcome of glycerol rhizolysis for trigeminal neuralgia

K. Singh Sahni, Daniel R. Pieper, Randy Anderson, and Nevan G. Baldwin

. 1, 9 The high recurrence rates noted in these reports may actually relate to compromised analysis of the time to pain recurrence data. We concur with the suggestion of Burchiel 1 that comparisons should be based on Kaplan-Meier estimation of the time to pain recurrence distribution. This report describes the experience of the first author (K.S.S.) in treating 58 cases of classical trigeminal neuralgia (TN) with PRGR. Most of the patients with TN who were referred to our center had already undergone extensive medical management; those who had not previously