Stereotactic radiosurgery for intractable cluster headache: an initial report from the North American Gamma Knife Consortium

Clinical article

View More View Less
  • 1 Departments of Neurological Surgery and
  • 2 Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;
  • 3 Department of Neurological Surgery, Université de Sherbrooke, Quebec, Canada;
  • 4 Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota; and
  • 5 Department of Neurological Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
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

The aim of this study was to evaluate the outcomes of Gamma Knife surgery (GKS) when used for patients with intractable cluster headache (CH).

Methods

Four participating centers of the North American Gamma Knife Consortium identified 17 patients who underwent GKS for intractable CH between 1996 and 2008. The median patient age was 47 years (range 26–83 years). The median duration of pain before GKS was 10 years (range 1.3–40 years). Seven patients underwent unsuccessful prior surgical procedures, including microvascular decompression (2 patients), microvascular decompression with glycerol rhizotomy (2 patients), deep brain stimulation (1 patient), trigeminal ganglion stimulation (1 patient), and prior GKS (1 patient). Fourteen patients had associated autonomic symptoms. The radiosurgical target was the trigeminal nerve (TN) root and the sphenopalatine ganglion (SPG) in 8 patients, only the TN in 8 patients, and only the SPG in 1 patient. The median maximum TN and SPG dose was 80 Gy.

Results

Favorable pain relief (Barrow Neurological Institute Grades I–IIIb) was achieved and maintained in 10 (59%) of 17 patients at a median follow-up of 34 months. Three patients required additional procedures (repeat GKS in 2 patients, hypothalamic deep brain stimulation in 1 patient). Eight (50%) of 16 patients who had their TN irradiated developed facial sensory dysfunction after GKS.

Conclusions

Gamma Knife surgery for intractable, medically refractory CH provided lasting pain reduction in approximately 60% of patients, but was associated with a significantly greater chance of facial sensory disturbances than GKS used for trigeminal neuralgia.

Abbreviations used in this paper: BNI = Barrow Neurological Institute; CH = cluster headache; DBS = deep brain stimulation; DHE-45 = dihydroergotamine; GKS = Gamma Knife surgery; MVD = microvascular decompression; NAGKC = North American Gamma Knife Consortium; SPG = sphenopalatine ganglion; SRS = stereotactic radiosurgery; TN = trigeminal nerve; UPMC = University of Pittsburgh Medical Center.

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: L. Dade Lunsford, M.D., University of Pittsburgh, Suite B-400, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, Pennsylvania 15213. email: lunsfordld@upmc.edu.

Please include this information when citing this paper: published online April 30, 2010; DOI: 10.3171/2010.3.JNS091843.

  • 1

    Bahra A, , May A, & Goadsby PJ: Cluster headache: a prospective clinical study with diagnostic implications. Neurology 58:354361, 2002

  • 2

    Burchiel KJ: A new classification for facial pain. Neurosurgery 53:11641167, 2003

  • 3

    Devoghel JC: Cluster headache and sphenopalatine block. Acta Anaesthesiol Belg 32:101107, 1981

  • 4

    Donnet A, , Tamura M, , Valade D, & Régis J: Trigeminal nerve radiosurgical treatment in intractable chronic cluster headache: unexpected high toxicity. Neurosurgery 59:12521257, 2006

    • Search Google Scholar
    • Export Citation
  • 5

    Donnet A, , Valade D, & Régis J: Gamma knife treatment for refractory cluster headache: prospective open trial. J Neurol Neurosurg Psychiatry 76:218221, 2005

    • Search Google Scholar
    • Export Citation
  • 6

    Fanciullacci M, , Pietrini U, , Gatto G, , Boccuni M, & Sicuteri F: Latent dysautonomic pupillary lateralization in cluster headache. A pupillometric study. Cephalalgia 2:135144, 1982

    • Search Google Scholar
    • Export Citation
  • 7

    Ford RG, , Ford KT, , Swaid S, , Young P, & Jennelle R: Gamma knife treatment of refractory cluster headache. Headache 38:39, 1998

  • 8

    Franzini A, , Ferroli P, , Leone M, & Broggi G: Stimulation of the posterior hypothalamus for treatment of chronic intractable cluster headaches: first reported series. Neurosurgery 52:10951101, 2003

    • Search Google Scholar
    • Export Citation
  • 9

    Jarrar RG, , Black DF, , Dodick DW, & Davis DH: Outcome of trigeminal nerve section in the treatment of chronic cluster headache. Neurology 60:13601362, 2003

    • Search Google Scholar
    • Export Citation
  • 10

    Kirkpatrick PJ, , O'Brien MD, & MacCabe JJ: Trigeminal nerve section for chronic migrainous neuralgia. Br J Neurosurg 7:483490, 1993

  • 11

    Kondziolka D, , Lacomis D, , Niranjan A, , Mori Y, , Maesawa S, & Fellows W, : Histological effects of trigeminal nerve radiosurgery in a primate model: implications for trigeminal neuralgia radiosurgery. Neurosurgery 46:971977, 2000

    • Search Google Scholar
    • Export Citation
  • 12

    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 112:758765, 2010

    • Search Google Scholar
    • Export Citation
  • 13

    Lad SP, , Lipani JD, , Gibbs IC, , Chang SD, , Adler JR Jr, & Henderson JM: Cyberknife targeting the pterygopalatine ganglion for the treatment of chronic cluster headaches. Neurosurgery 60:E580E581, 2007

    • Search Google Scholar
    • Export Citation
  • 14

    Leone M: Chronic cluster headache: new and emerging treatment options. Curr Pain Headache Rep 8:347352, 2004

  • 15

    Leone M, , Franzini A, , Broggi G, & Bussone G: Hypothalamic deep brain stimulation for intractable chronic cluster headache: a 3-year follow-up. Neurol Sci 24:Suppl 2 S143S145, 2003

    • Search Google Scholar
    • Export Citation
  • 16

    Leone M, , May A, , Franzini A, , Broggi G, , Dodick D, & Rapoport A, : Deep brain stimulation for intractable chronic cluster headache: proposals for patient selection. Cephalalgia 24:934937, 2004

    • Search Google Scholar
    • Export Citation
  • 17

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

    • Search Google Scholar
    • Export Citation
  • 18

    Matharu MS, & Goadsby PJ: Persistence of attacks of cluster headache after trigeminal nerve root section. Brain 125:976984, 2002

  • 19

    Mathew NT, & Hurt W: Percutaneous radiofrequency trigeminal gangliorhizolysis in intractable cluster headache. Headache 28:328331, 1988

    • Search Google Scholar
    • Export Citation
  • 20

    May A: Cluster headache: pathogenesis, diagnosis, and management. Lancet 366:843855, 2005

  • 21

    McClelland S III, , Barnett GH, , Neyman G, & Suh JH: Repeat trigeminal nerve radiosurgery for refractory cluster headache fails to provide long-term pain relief. Headache 47:298300, 2007

    • Search Google Scholar
    • Export Citation
  • 22

    McClelland S III, , Tendulkar RD, , Barnett GH, , Neyman G, & Suh JH: Long-term results of radiosurgery for refractory cluster headache. Neurosurgery 59:12581263, 2006

    • Search Google Scholar
    • Export Citation
  • 23

    Pieper DR, , Dickerson J, & Hassenbusch SJ: Percutaneous retrogasserian glycerol rhizolysis for treatment of chronic intractable cluster headaches: long-term results. Neurosurgery 46:363370, 2000

    • Search Google Scholar
    • Export Citation
  • 24

    Pollock BE, & Kondziolka D: Stereotactic radiosurgical treatment of sphenopalatine neuralgia. Case report. J Neurosurg 87:450453, 1997

  • 25

    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
  • 26

    Régis J, , Metellus P, , Hayashi M, , Roussel P, , 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
  • 27

    Rogers CL, , Shetter AG, , Fiedler 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
  • 28

    Salar G, , Ori C, , Iob I, & Fiore D: Percutaneous thermocoagulation for sphenopalatine ganglion neuralgia. Acta Neurochir (Wien) 84:2428, 1987

    • Search Google Scholar
    • Export Citation
  • 29

    Sanders M, & Zuurmond WW: Efficacy of sphenopalatine ganglion blockade in 66 patients suffering from cluster headache: a 12- to 70-month follow-up evaluation. J Neurosurg 87:876880, 1997

    • Search Google Scholar
    • Export Citation
  • 30

    Solomon S, & Apfelbaum RI: Surgical decompression of the facial nerve in the treatment of chronic cluster headache. Arch Neurol 43:479482, 1986

    • Search Google Scholar
    • Export Citation
  • 31

    Taha JM, & Tew JM Jr: Long-term results of radiofrequency rhizotomy in the treatment of cluster headache. Headache 35:193196, 1995

Metrics

All Time Past Year Past 30 Days
Abstract Views 496 178 8
Full Text Views 250 27 3
PDF Downloads 155 18 1
EPUB Downloads 0 0 0