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

Clinical article

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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.

Article Information

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.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Flowchart of prior patient treatment, post-GKS modalities, and outcomes. FU = follow-up.

  • View in gallery

    Radiosurgical dose plan images obtained in a 26-year-old man who presented with intractable right-sided CH. The dose plan was designed using axial spoiled-gradient recalled contrast-enhanced MR images. The dose plan shows 50% isodose line covering both the TN and SPG. The right TN was targeted with an 80-Gy central dose using a 4-mm collimator (right) and the right SPG was targeted with an 80-Gy central dose using an 8-mm collimator (left).

  • View in gallery

    Kaplan-Meier estimate of probability of initial pain relief after GKS.

  • View in gallery

    Kaplan-Meier estimate of maintaining pain relief after GKS.

References

1

Bahra AMay AGoadsby PJ: Cluster headache: a prospective clinical study with diagnostic implications. Neurology 58:3543612002

2

Burchiel KJ: A new classification for facial pain. Neurosurgery 53:116411672003

3

Devoghel JC: Cluster headache and sphenopalatine block. Acta Anaesthesiol Belg 32:1011071981

4

Donnet ATamura MValade DRégis J: Trigeminal nerve radiosurgical treatment in intractable chronic cluster headache: unexpected high toxicity. Neurosurgery 59:125212572006

5

Donnet AValade DRégis J: Gamma knife treatment for refractory cluster headache: prospective open trial. J Neurol Neurosurg Psychiatry 76:2182212005

6

Fanciullacci MPietrini UGatto GBoccuni MSicuteri F: Latent dysautonomic pupillary lateralization in cluster headache. A pupillometric study. Cephalalgia 2:1351441982

7

Ford RGFord KTSwaid SYoung PJennelle R: Gamma knife treatment of refractory cluster headache. Headache 38:391998

8

Franzini AFerroli PLeone MBroggi G: Stimulation of the posterior hypothalamus for treatment of chronic intractable cluster headaches: first reported series. Neurosurgery 52:109511012003

9

Jarrar RGBlack DFDodick DWDavis DH: Outcome of trigeminal nerve section in the treatment of chronic cluster headache. Neurology 60:136013622003

10

Kirkpatrick PJO'Brien MDMacCabe JJ: Trigeminal nerve section for chronic migrainous neuralgia. Br J Neurosurg 7:4834901993

11

Kondziolka DLacomis DNiranjan AMori YMaesawa SFellows W: Histological effects of trigeminal nerve radiosurgery in a primate model: implications for trigeminal neuralgia radiosurgery. Neurosurgery 46:9719772000

12

Kondziolka DZorro OLobato-Polo JKano HFlannery TJFlickinger JC: Gamma Knife stereotactic radiosurgery for idiopathic trigeminal neuralgia. Clinical article. J Neurosurg 112:7587652010

13

Lad SPLipani JDGibbs ICChang SDAdler JR JrHenderson JM: Cyberknife targeting the pterygopalatine ganglion for the treatment of chronic cluster headaches. Neurosurgery 60:E580E5812007

14

Leone M: Chronic cluster headache: new and emerging treatment options. Curr Pain Headache Rep 8:3473522004

15

Leone MFranzini ABroggi GBussone G: Hypothalamic deep brain stimulation for intractable chronic cluster headache: a 3-year follow-up. Neurol Sci 24:Suppl 2S143S1452003

16

Leone MMay AFranzini ABroggi GDodick DRapoport A: Deep brain stimulation for intractable chronic cluster headache: proposals for patient selection. Cephalalgia 24:9349372004

17

Maesawa SSalame CFlickinger JCPirris SKondziolka DLunsford LD: Clinical outcomes after stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 94:14202001

18

Matharu MSGoadsby PJ: Persistence of attacks of cluster headache after trigeminal nerve root section. Brain 125:9769842002

19

Mathew NTHurt W: Percutaneous radiofrequency trigeminal gangliorhizolysis in intractable cluster headache. Headache 28:3283311988

20

May A: Cluster headache: pathogenesis, diagnosis, and management. Lancet 366:8438552005

21

McClelland S IIIBarnett GHNeyman GSuh JH: Repeat trigeminal nerve radiosurgery for refractory cluster headache fails to provide long-term pain relief. Headache 47:2983002007

22

McClelland S IIITendulkar RDBarnett GHNeyman GSuh JH: Long-term results of radiosurgery for refractory cluster headache. Neurosurgery 59:125812632006

23

Pieper DRDickerson JHassenbusch SJ: Percutaneous retrogasserian glycerol rhizolysis for treatment of chronic intractable cluster headaches: long-term results. Neurosurgery 46:3633702000

24

Pollock BEKondziolka D: Stereotactic radiosurgical treatment of sphenopalatine neuralgia. Case report. J Neurosurg 87:4504531997

25

Pollock BEPhuong LKGorman DAFoote RLStafford SL: Stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 97:3473532002

26

Régis JMetellus PHayashi MRoussel PDonnet ABille-Turc F: Prospective controlled trial of gamma knife surgery for essential trigeminal neuralgia. J Neurosurg 104:9139242006

27

Rogers CLShetter AGFiedler JASmith KAHan PPSpeiser BL: Gamma knife radiosurgery for trigeminal neuralgia: the initial experience of The Barrow Neurological Institute. Int J Radiat Oncol Biol Phys 47:101310192000

28

Salar GOri CIob IFiore D: Percutaneous thermocoagulation for sphenopalatine ganglion neuralgia. Acta Neurochir (Wien) 84:24281987

29

Sanders MZuurmond WW: Efficacy of sphenopalatine ganglion blockade in 66 patients suffering from cluster headache: a 12- to 70-month follow-up evaluation. J Neurosurg 87:8768801997

30

Solomon SApfelbaum RI: Surgical decompression of the facial nerve in the treatment of chronic cluster headache. Arch Neurol 43:4794821986

31

Taha JMTew JM Jr: Long-term results of radiofrequency rhizotomy in the treatment of cluster headache. Headache 35:1931961995

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