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Chuan-Fu Huang, Hsien-Tang Tu, Wen-Shan Liu, Shyh-Ying Chiou and Long-Yau Lin

adequately control their pain. We proposed the use of GKS as a repeated treatment strategy and studied whether it could enhance the efficacy of GKS in terms of its less invasive role. Methods Patient Population Between July 1999 and September 2005, a total of 118 patients with idiopathic TN underwent GKS at our center. This was the primary treatment for 89 of these patients. The follow-up period was ≥ 2 years. The mean duration of symptoms was 36 months (range 4–124 months). There were 46 (52%) females and 43 (48%) males. The characteristics of these 89 patients

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Brent Y. Kimball, Jeffrey M. Sorenson and David Cunningham

Knife surgery used as primary and repeated treatment for idiopathic trigeminal neuralgia . J Neurosurg 109 : Suppl 179 – 184 , 2008 14 Jho HD , Lunsford LD : Percutaneous retrogasserian glycerol rhizotomy. Current technique and results . Neurosurg Clin N Am 8 : 63 – 74 , 1997 15 Kondziolka D , Zorro O , Lobato-Polo J , Kano H , Flannery TJ , Flickinger JC , : Gamma Knife stereotactic radiosurgery for idiopathic trigeminal neuralgia. Clinical article . J Neurosurg 112 : 758 – 765 , 2010 16 Maesawa S , Salame C

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Dusan Urgosik, Roman Liscak, Josef Novotny Jr., Josef Vymazal and Vilibald Vladyka

Object. The authors present the long-term follow-up results (minimum 5 years) of patients with essential trigeminal neuralgia (TN) who were treated with gamma knife surgery (GKS).

Methods. One hundred seven patients (61 females and 46 males) underwent GKS. The median follow up was time was 60 months (range 12–96 months). The target was the trigeminal root, and the maximum dose was 70 to 80 Gy. Repeated GKS was performed in 19 patients for recurrent pain, and the same dose was used.

Initial successful results were achieved in 96% of patients, with complete pain relief in 80.4%. Relief was achieved after a median latency of 3 months (range 1 day–13 months). Gamma knife surgery failed in 4% of patients. Pain recurred in 25% of patients after a median latent interval of 36 months (6–94 months). The initial success rate after a second GKS was 89% and 58% of patients were pain free. Pain relapse occurred in only one patient in this group. Hypesthesia was observed in 20% of patients after the first GKS and in 32% after the second GKS. The median interval to hypaesthesia was 35 months (range 3–94 months) after one treatment and 21 months (range 1–72 months) after a second treatment.

Conclusions. The initial success rate of pain relief was high and comparable to that reported in other studies. A higher than usual incidence of sensory impairment after GKS could be the long duration of follow-up study and due to the detailed neurological examination.

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Max K. Kole, David M. Pelz, Paul Kalapos, Donald H. Lee, Irene B. Gulka and Stephen P. Lownie

regression analyses were used to examine demographic, anatomical, and technical factors associated with the immediate posttreatment result, that is, Class I, II, or III. The time to the first negative event and factors associated with a remnant increase, repeated treatment, rebleeding, or death during periprocedure hospitalization were determined using univariate and multivariate Cox regression analyses. Results Immediate Posttreatment Angiographic Results Immediate posttreatment angiographic results were available in 151 (94.3%) of 160 patients. In six

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J. Paul Elliott, David W. Newell, Derek J. Lam, Joseph M. Eskridge, Colleen M. Douville, Peter D. Le Roux, David H. Lewis, Marc R. Mayberg, M. Sean Grady and H. Richard Winn

balloon angioplasty or papaverine infusion by using TCD monitoring of both the absolute velocity of blood flow and the intracranial/extracranial velocity ratio. Pretreatment velocity (Day 0) was compared to the velocity at 24 (postoperative Day 1) and 48 hours posttreatment (postoperative Day 2) for each vessel segment using the one-tailed, paired-samples t-test. Vessels initally treated with a combination of the two methods were excluded from this analysis. Vessels treated successively with papaverine infusion and then balloon angioplasty, or with repeated treatment

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Satoshi Maesawa, John C. Flickinger, Douglas Kondziolka and L. Dade Lunsford

suggest that optimum management requires information on the location of the residual nidus (in field or out of field with respect to the first treatment volume). The margin dose used for repeated radiosurgery is the best predictor of obliteration. The dose—response curve for repeated radiosurgery found in this study was similar to that for initial radiosurgery. This indicates that dose prescriptions should not be reduced for repeated treatment compared with those given during the initial radiosurgery. Higher margin doses may be required for obliteration of an out

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Kelly D. Foote, William A. Friedman, Thomas L. Ellis, Frank J. Bova, John M. Buatti and Sanford L. Meeks

initial and repeated treatments was 41 months (range 36–70 months). The radiosurgical procedures used for repeated treatments were the same as those for primary AVM radiosurgery. After an optimal dose plan was derived for each residual AVM, its volume was estimated using our standard dose-volume histogram technique, with which we compute the volume of the prescription isodose shell conforming to the lesion. Dose selection for retreatment was based primarily on target volume and location, regardless of prior treatment. Lesion volume, Spetzler—Martin 20 grade, and

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Chuan-Fu Huang, Hsien-Tang Tu, Wen-Shan Liu and Long-Yau Lin

, repeated treatment for intractable idiopathic trigeminal neuralgia had enhanced results. 6 The time interval between the first and second GKS procedure was as long as 3–4 years, and this also reflects that pain relief via medication will inevitably fail. Additionally only long-term observation can reveal the final results. Our excellent pain outcome is similar to that reported by Regis et al., 17 but instead of our second-stage boost their strategy was to use a higher dose to the trigeminal nerve root the first time. TABLE 5 Groups using radiosurgery to treat

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Gregory J. Zipfel, Patrick Bradshaw, Frank J. Bova and William A. Friedman

the other institution after treatment. The morphological features of the AVM were identified through a review of all data as described later in this paper. In addition, the radiosurgery database was perused for determination of the following patient or treatment factors for subsequent statistical analyses: age, pretreatment hemorrhage (yes or no), Spetzler—Martin grade, whether this was a repeated treatment (yes or no), radiosurgical dose, posttreatment hemorrhage (yes or no), and neuroimaging-defined success (yes or no). Morphological Features of AVMs The

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J. Paul Elliott, David W. Newell, Derek J. Lam, Joseph M. Eskridge, Colleen M. Douville, Peter D. LeRoux, David H. Lewis, Marc R. Mayberg, M. Sean Grady and H. Richard Winn

The authors used daily transcranial Doppler (TCD) evaluation to test the hypothesis that balloon angioplasty is superior to papaverine infusion for the treatment of proximal anterior circulation arterial vasospasm following subarachnoid hemorrhage (SAH). Between 1989 and 1995, 125 vasospastic distal internal carotid artery or proximal middle cerebral artery vessel segments were treated in 52 patients. Blood flow velocities of the involved vessels were assessed using TCD monitoring in relation to the day of treatment with balloon angioplasty or papaverine infusion. Balloon angioplasty and papavarine infusion cohorts were compared based on mean pretreatment velocity and mean posttreatment velocity at 24 and 48 hours using the one-tailed, paired-samples t-test. Balloon angioplasty alone was performed in 101 vessel segments (81%) in 39 patients (75%), whereas papaverine infusion alone was used in 24 vessel segments (19%) in 13 patients (25%). Although repeated treatment following balloon angioplasty was needed in only one vessel segment, repeated treatment following papaverine infusion was required in 10 vessel segments (42%) in six patients because of recurrent vasospasm (p < 0.001). Seven vessel segments (29%) with recurrent spasm following papaverine infusion were treated with balloon angioplasty. Although vessel segments treated with papaverine demonstrated a 20% mean decrease in blood flow velocity (p < 0.009) on posttreatment Day 1, velocities were not significantly lower than pretreatment levels by posttreatment Day 2 (p = 0.133). Balloon angioplasty resulted in a 45% mean decrease in velocity to a normal level following treatment (p < 0.001), which was sustained. The authors conclude that balloon angioplasty is superior to papaverine infusion for the permanent treatment of proximal anterior circulation vasospasm following aneurysmal SAH.