Clinical outcomes after Gamma Knife surgery for idiopathic trigeminal neuralgia: review of 76 consecutive cases

View More View Less
  • 1 Department of Neurosurgery, Santa Casa Hospital, Belo Horizonte, Brazil;
  • 2 Department of Neurosurgery, Hospital Roger Salengro, and
  • 3 Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object

Stereotactic radiosurgery is an increasingly used, and the least invasive, surgical option for patients with trigeminal neuralgia (TN). In this study, the authors performed a retrospective evaluation of the safety and efficacy of this method for idiopathic TN.

Methods

The authors reviewed data from 76 patients with idiopathic TN who underwent Gamma Knife surgery (GKS). The mean age of the patients was 64 years (range 27–83 years). All patients had typical features of TN. Thirty patients (39.5%) had previously undergone surgery. The intervention consisted of GKS on the retrogasserian cisternal portion of the fifth cranial nerve. The mean maximum GKS dose used was 85.1 Gy (range 75–90 Gy).

Results

Patients were followed-up from 6 to 42 months (mean 20.3 months) after GKS. Complete pain relief was achieved in 83.1% of the patients within 1 year, 70.9% within 2 years, and 62.5% within 3 years. Patients who underwent previous surgery demonstrated a lower rate of pain relief (p < 0.05). Twenty patients (26.3%) reported pain recurrence between 6 and 42 months after treatment. New or worsened persistent trigeminal dysfunction developed after GKS in 16 patients (21%); 8 of these patients described some facial numbness/not bothersome, and 8 reported some facial numbness/somewhat bothersome. None of the patients developed troublesome dysesthesia or anesthesia dolorosa.

Conclusions

Gamma Knife surgery for idiopathic TN proved to be safe and effective and was associated with a particularly low rate of complications.

Abbreviations used in this paper: BNI = Barrow Neurological Institute; GKS = Gamma Knife surgery; MVD = microvascular decompression; SRS = stereotactic radiosurgery; TN = trigeminal neuralgia.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Marcos Dellaretti, M.D., Department of Neurosurgery, Santa Casa Hospital, R Francisco Sales, SN, Belo Horizonte, Minas Gerais, 30130-310, Brazil. email: mdellaretti@mac.com.
  • 1

    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 334:10771083, 1996

    • Search Google Scholar
    • Export Citation
  • 2

    Brisman R, & Mooij R: Gamma Knife radiosurgery for trigeminal neuralgia: dose-volume histograms of the brainstem and trigeminal nerve. J Neurosurg 93:3 Suppl 155158, 2000

    • Search Google Scholar
    • Export Citation
  • 3

    Brown JA, & Pilitsis JG: Percutaneous balloon compression for the treatment of trigeminal neuralgia: results in 56 patients based on balloon compression pressure monitoring. Neurosurg Focus 18:1015, 2005

    • Search Google Scholar
    • Export Citation
  • 4

    Fountas KN, , Smith JR, , Lee GP, , Jenkins PD, , Cantrell RR, & Sheils C: Gamma Knife stereotactic radiosurgical treatment of idiopathic trigeminal neuralgia: long-term outcome and complications. Neurosurg Focus 23:17, 2007

    • Search Google Scholar
    • Export Citation
  • 5

    Kaplan EL, & Meier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457481, 1958

  • 6

    Kondziolka D, , Flickinger JC, , Lunsford LD, & Habeck M: Trigeminal neuralgia radiosurgery: the University of Pittsburg experience. Stereotact Funct Neurosurg 66:1 Suppl 343348, 1996

    • Search Google Scholar
    • Export Citation
  • 7

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

    • Search Google Scholar
    • Export Citation
  • 8

    Kondziolka D, , Lunsford LD, , Flickinger JC, , Young RF, , Vermeulen S, & Duma CM, : Stereotactic radiosurgery for trigeminal neuralgia: a multiinstitutional study using gamma unit. J Neurosurg 84:940945, 1996

    • Search Google Scholar
    • Export Citation
  • 9

    Kondziolka D, , Perez B, , Flickinger JC, , Habeck M, & Lunsford LD: Gamma knife radiosurgery for trigeminal neuralgia. Results and expectations. Arch Neurol 55:15241529, 1998

    • Search Google Scholar
    • Export Citation
  • 10

    Leksell L: Steoreotatic radiosurgery in trigeminal neuralgia. Acta Chir Scand 137:311314, 1971

  • 11

    Leksell L: Stereotactic radiosurgery. J Neurol Neurosurg Psychiatry 46:797803, 1983

  • 12

    Longhi M, , Rizzo P, , Nicolato A, , Foroni R, , Reggio M, & Gerosa M: Gamma knife radiosurgery for trigeminal neuralgia: results and potentially predictive parameters-part I: Idiopathic trigeminal neuralgia. Neurosurgery 61:12541260, 2007

    • Search Google Scholar
    • Export Citation
  • 13

    Lopez BC, , Hamlyn PJ, & Zakrzewska JM: Systematic review of ablative neurosurgical techniques for the treatment of trigeminal neuralgia. Neurosurgery 54:973982, 2004

    • Search Google Scholar
    • Export Citation
  • 14

    Lunsford LD, & Apfelbaum RI: Choice of surgical therapeutic modalities for treatment of trigeminal neuralgia. Microvascular decompression, percutaneous retrogasserian thermal, or glycerol rhizotomy. Clin Neurosurg 32:319333, 1985

    • Search Google Scholar
    • Export Citation
  • 15

    Maesawa S, , Salame C, , Flickinger JC, , Pirris S, , Kondziolka D, & Lunsford LD: Clinical outcomes after radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 94:1420, 2001

    • Search Google Scholar
    • Export Citation
  • 16

    Massager N, , Lorenzoni J, , Devriendt D, , Desmedt F, , Brotchi J, & Levivier M: Gamma knife surgery for idiopathic trigeminal neuralgia performed using a far-anterior cisternal target and a high dose of radiation. J Neurosurg 100:597605, 2004

    • Search Google Scholar
    • Export Citation
  • 17

    Massager N, , Murata N, , Tamura M, , Devriendt D, , Levivier M, & Régis J: Influence of nerve radiation dose in the incidence of trigeminal dysfunction after trigeminal neuralgia radiosurgery. Neurosurgery 60:681688, 2007

    • Search Google Scholar
    • Export Citation
  • 18

    Nicol B, , Regine WF, , Courtney C, , Meigooni A, , Sanders M, & Young B: Gamma knife radiosurgery using 90 Gy for trigeminal neuralgia. J Neurosurg 93:3 Suppl 152154, 2000

    • Search Google Scholar
    • Export Citation
  • 19

    Pollock BE, , Phuong LK, , Gorman DA, , Foote RL, & Stafford SL: Stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 97:347353, 2002

    • Search Google Scholar
    • Export Citation
  • 20

    Pollock BE: Comparison of posterior fossa exploration and stereotactic radiosurgery in patients with previously nonsurgically treated idiopathic trigeminal neuralgia. Neurosurg Focus 18:14, 2005

    • Search Google Scholar
    • Export Citation
  • 21

    Rand RW, , Jacques DB, , Melbye RW, , Copcutt BG, , Levenick MN, & Fisher MR: Leksell gamma knife treatment of tic douleureux. Stereotact Funct Neurosurg 61:1 Suppl 93102, 1993

    • Search Google Scholar
    • Export Citation
  • 22

    Régis J, , Batolomei F, , Metellus P, , Rey M, , Genton P, & Dravet C, : Radiosurgery for trigeminal neuralgia and epilepsy. Neurosurg Clin N Am 10:359377, 1999

    • Search Google Scholar
    • Export Citation
  • 23

    Régis J, , Metellus P, , Hayashi M, , Roussel R, , Donnet A, & Bille-Turc F: Prospective controlled trial of gamma knife surgery for essential trigeminal neuralgia. J Neurosurg 104:913924, 2006

    • Search Google Scholar
    • Export Citation
  • 24

    Régis J, , Metellus P, , Lazorthes Y, , Porcheron D, & Peragut JC: Effect of gamma knife on secondary trigeminal neuralgia. Stereotact Funct Neurosurg 70:1 Suppl 210217, 1998

    • Search Google Scholar
    • Export Citation
  • 25

    Rogers CL, , Shetter AG, , Fieldler JA, , Smith KA, , Han PP, & Speiser BL: Gamma Knife radiosurgery for trigeminal neuralgia: the initial experience of The Barrow Neurological Institute. Int J Radiat Oncol Biol Phys 47:10131019, 2000

    • Search Google Scholar
    • Export Citation
  • 26

    Shaya M, , Jawahar A, , Caldito G, , Sin A, , Willis BK, & Nanda A: Gamma knife radiosurgery for trigeminal neuralgia: a study of predictors of success, efficacy, safety, and outcome at LSUHSC. Surg Neurol 61:529535, 2004

    • Search Google Scholar
    • Export Citation
  • 27

    Sheehan J, , Pan HC, , Stroila M, & Steiner L: Gamma knife surgery for trigeminal neuralgia: outcomes and prognostic factors. J Neurosurg 102:434441, 2005

    • Search Google Scholar
    • Export Citation
  • 28

    Urgosik D, , Vymazal J, , Vladyka V, & Liscak R: Gamma knife treatment of trigeminal neuralgia: clinical and electrophysiological study. Stereotact Funct Neurosurg 70:1 Suppl 200209, 1998

    • Search Google Scholar
    • Export Citation
  • 29

    Young RF, , Vermeulen SS, , Grimm P, , Blasko J, & Posewitz A: Gamma knife radiosurgery for treatment of trigeminal neuralgia: idiopathic and tumor related. Neurology 48:608614, 1997

    • Search Google Scholar
    • Export Citation
  • 30

    Young RF, , Vermeulen S, & Posewitz A: Gamma knife radiosurgery for the treatment of trigeminal neuralgia. Stereotact Funct Neurosurg 70:1 Suppl 192199, 1998

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 394 61 7
Full Text Views 121 2 0
PDF Downloads 81 2 0
EPUB Downloads 0 0 0