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

Clinical article

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


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.


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.


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:

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.



  • View in gallery

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

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    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.



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