Stereotactic radiosurgery for trigeminal neuralgia: a systematic review

International Stereotactic Radiosurgery Society practice guidelines

Restricted access

OBJECTIVES

The aims of this systematic review are to provide an objective summary of the published literature specific to the treatment of classical trigeminal neuralgia with stereotactic radiosurgery (RS) and to develop consensus guideline recommendations for the use of RS, as endorsed by the International Society of Stereotactic Radiosurgery (ISRS).

METHODS

The authors performed a systematic review of the English-language literature from 1951 up to December 2015 using the Embase, PubMed, and MEDLINE databases. The following MeSH terms were used in a title and abstract screening: “radiosurgery” AND “trigeminal.” Of the 585 initial results obtained, the authors performed a full text screening of 185 studies and ultimately found 65 eligible studies. Guideline recommendations were based on level of evidence and level of consensus, the latter predefined as at least 85% agreement among the ISRS guideline committee members.

RESULTS

The results for 65 studies (6461 patients) are reported: 45 Gamma Knife RS (GKS) studies (5687 patients [88%]), 11 linear accelerator (LINAC) RS studies (511 patients [8%]), and 9 CyberKnife RS (CKR) studies (263 patients [4%]). With the exception of one prospective study, all studies were retrospective.

The mean maximal doses were 71.1–90.1 Gy (prescribed at the 100% isodose line) for GKS, 83.3 Gy for LINAC, and 64.3–80.5 Gy for CKR (the latter two prescribed at the 80% or 90% isodose lines, respectively). The ranges of maximal doses were as follows: 60–97 Gy for GKS, 50–90 Gy for LINAC, and 66–90 Gy for CKR.

Actuarial initial freedom from pain (FFP) without medication ranged from 28.6% to 100% (mean 53.1%, median 52.1%) for GKS, from 17.3% to 76% (mean 49.3%, median 43.2%) for LINAC, and from 40% to 72% (mean 56.3%, median 58%) for CKR. Specific to hypesthesia, the crude rates (all Barrow Neurological Institute Pain Intensity Scale scores included) ranged from 0% to 68.8% (mean 21.7%, median 19%) for GKS, from 11.4% to 49.7% (mean 27.6%, median 28.5%) for LINAC, and from 11.8% to 51.2% (mean 29.1%, median 18.7%) for CKR. Other complications included dysesthesias, paresthesias, dry eye, deafferentation pain, and keratitis. Hypesthesia and paresthesia occurred as complications only when the anterior retrogasserian portion of the trigeminal nerve was targeted, whereas the other listed complications occurred when the root entry zone was targeted. Recurrence rates ranged from 0% to 52.2% (mean 24.6%, median 23%) for GKS, from 19% to 63% (mean 32.2%, median 29%) for LINAC, and from 15.8% to 33% (mean 25.8%, median 27.2%) for CKR. Two GKS series reported 30% and 45.3% of patients who were pain free without medication at 10 years.

CONCLUSIONS

The literature is limited in its level of evidence, with only one comparative randomized trial (1 vs 2 isocenters) reported to date. At present, one can conclude that RS is a safe and effective therapy for drug-resistant trigeminal neuralgia. A number of consensus statements have been made and endorsed by the ISRS.

ABBREVIATIONS BMC = balloon microcompression; BNI = Barrow Neurological Institute; CKR = CyberKnife radiosurgery; DVH = dose-volume histogram; FFP = freedom from pain; GKS = Gamma Knife surgery; HSRT = hypofractionated stereotactic radiotherapy; ISRS = International Society of Stereotactic Radiosurgery; LINAC = linear accelerator; MVD = microvascular decompression; QOL = quality of life; RCT = randomized controlled trial; REZ = root entry zone; RFT = radiofrequency thermocoagulation; RS = radiosurgery; SCA = superior cerebellar artery; TN = trigeminal neuralgia; TTPR = time to pain relief.

Article Information

Correspondence Constantin Tuleasca: Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. email: constantin.tuleasca@gmail.com.

INCLUDE WHEN CITING Published online April 27, 2018; DOI: 10.3171/2017.9.JNS17545.

C.T. and J.R. contributed equally to this study.

Disclosures Mr. Paddick has been a consultant for Elekta AB. Dr. Régis has been a consultant for Medtronic and has received support from Elekta for non–study-related clinical or research effort. Dr. Sahgal has received honoraria for past educational seminars from Medtronic, Elekta AB, Accuray Inc., and Varian Medical Systems and research grants from Elekta AB and belongs to the Elekta MR LINAC Research Consortium.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Flow chart to final number of eligible studies.

  • View in gallery

    Examples of different types of targeting (simulation), including the plexus triangularis (A), retrogasserian portion (far anterior cisternal, B), REZ with 30% isodose line overlapping the brainstem (C), and the use of 2 isocenters (D). Purple line indicates the brainstem area (for further DVH measurements; light blue line, the trigeminal nerve; green line, the 50% isodose line; and dark blue area, approximate middle point of trigeminal nerve, in the retrogasserian area. Figure is available in color online only.

  • View in gallery

    When initial efficacy was pooled (A), there was no statistically significant difference between the retrogasserian and the REZ target, with an HR = 1.44 (95% CI 0.78, 2.68), p = 0.25. For toxicity (B), there was a statistically significant increase in the REZ group, with an HR = 1.78 (95% CI 1.04, 3.05), p = 0.03. For the maintenance of pain relief (C), there was no statistically significant difference between the two targets, with an HR = 1.69 (95% CI 0.78, 3.65), p = 0.18. Figure is available in color online only.

  • View in gallery

    When initial efficacy was pooled (A), there was no statistically significant difference between 1 and 2 isocenters, with an HR = 1.21 (95% CI 0.40, 3.68), p = 0.74. For toxicity (B), there was no statistically significant difference in the number of isocenters used, with an HR = 0.82 (95% CI 0.41, 1.65), p = 0.58; however, the study by Flickinger et al.32 clearly shows a major increase in toxicity with 2-isocenter use. Figure is available in color online only.

  • View in gallery

    When initial efficacy was pooled (A), there was a statistically significant difference between cases with prior MVD and those without, with an HR = 7.08 (95% CI 3.76, 13.34), p < 0.00001. For the maintenance of pain relief on a long-term basis (B), there was no statistically significant difference, with an HR = 1.20 (95% CI 0.65, 2.24), p = 0.56. Figure is available in color online only.

  • View in gallery

    When the maintenance of pain relief on a long-term basis was compared between MVD and GKS, there was a statistically significant difference, with an HR = −0.29 (95% CI −0.49, −0.10), p = 0.003. Figure is available in color online only.

References

  • 1

    Adler JR JrBower RGupta GLim MEfron AGibbs IC: Nonisocentric radiosurgical rhizotomy for trigeminal neuralgia. Neurosurgery 64 (2 Suppl):A84A902009

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2

    Alberico RAFenstermaker RALobel J: Focal enhancement of cranial nerve V after radiosurgery with the Leksell gamma knife: experience in 15 patients with medically refractory trigeminal neuralgia. AJNR Am J Neuroradiol 22:194419482001

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Alexander ELoeffler JSLunsford DL (eds): Stereotactic Radiosurgery. New York: McGraw-Hill1993 Vol 1

  • 4

    Alpert TEChung CTMitchell LTHodge CJMontgomery CTBogart JA: Gamma knife surgery for trigeminal neuralgia: improved initial response with two isocenters and increasing dose. J Neurosurg 102 Suppl:1851882005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    André N: Observations pratiques sur les maladies de l’urethre. Paris: Delaguette1756

    • Export Citation
  • 6

    Arai YKano HLunsford LDNovotny J JrNiranjan AFlickinger JC: Does the Gamma Knife dose rate affect outcomes in radiosurgery for trigeminal neuralgia? J Neurosurg 113 Suppl:1681712010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Attia ATatter SBWeller MMarshall KLovato JFBourland JD: CT-only planning for Gamma Knife radiosurgery in the treatment of trigeminal neuralgia: methodology and outcomes from a single institution. J Med Imaging Radiat Oncol 56:4904942012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Aykol ŞBörcek Emmez HÖcal ÖPaşaoğlu A: Results of radiosurgery for trigeminal neuralgia: Ankara experience. Br J Neurosurg 29:54582014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Azar MYahyavi STBitaraf MAGazik FKAllahverdi MShahbazi S: Gamma knife radiosurgery in patients with trigeminal neuralgia: quality of life, outcomes, and complications. Clin Neurol Neurosurg 111:1741782009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Balamucki CJStieber VWEllis TLTatter SBDeguzman AFMcMullen KP: Does dose rate affect efficacy? The outcomes of 256 Gamma Knife surgery procedures for trigeminal neuralgia and other types of facial pain as they relate to the half-life of cobalt. J Neurosurg 105:7307352006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Barker FG IIJannetta PJBissonette DJLarkins MVJho HD: The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334:107710831996

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Borchers JD IIIYang HJSakamoto GTHowes GAGupta GChang SD: Cyberknife stereotactic radiosurgical rhizotomy for trigeminal neuralgia: anatomic and morphological considerations. Neurosurgery 64 (2 Suppl):A91A952009

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13

    Brisman R: Gamma knife radiosurgery for primary management for trigeminal neuralgia. J Neurosurg 93 (Suppl 3):1591612000

  • 14

    Brisman RKhandji AGMooij RB: Trigeminal nerve-blood vessel relationship as revealed by high-resolution magnetic resonance imaging and its effect on pain relief after gamma knife radiosurgery for trigeminal neuralgia. Neurosurgery 50:126112672002

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Brisman RMooij R: Gamma knife radiosurgery for trigeminal neuralgia: dose-volume histograms of the brainstem and trigeminal nerve. J Neurosurg 93 (Suppl 3):1551582000

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Brown JAMcDaniel MDWeaver MT: Percutaneous trigeminal nerve compression for treatment of trigeminal neuralgia: results in 50 patients. Neurosurgery 32:5705731993

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Chang JWChang JHPark YGChung SS: Gamma knife radiosurgery for idiopathic and secondary trigeminal neuralgia. J Neurosurg 93 (Suppl 3):1471512000

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Chen JCGirvigian MGreathouse HMiller MRahimian J: Treatment of trigeminal neuralgia with linear accelerator radiosurgery: initial results. J Neurosurg 101 (Suppl 3):3463502004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Chen JCRahimian JRahimian RArrelano AMiller MJGirvigian MR: Frameless image-guided radiosurgery for initial treatment of typical trigeminal neuralgia. World Neurosurg 75:5385432010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20

    Cheng JSLim DAChang EFBarbaro NM: A review of percutaneous treatments for trigeminal neuralgia. Neurosurgery [epub ahead of print] 2013

  • 21

    Cheuk AVChin LSPetit JHHerman JMFang HBRegine WF: Gamma knife surgery for trigeminal neuralgia: outcome, imaging, and brainstem correlates. Int J Radiat Oncol Biol Phys 60:5375412004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Cruccu GFinnerup NBJensen TSScholz JSindou MSvensson P: Trigeminal neuralgia: new classification and diagnostic grading for practice and research. Neurology 87:2202282016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Dandy W: Concerning the cause of trigeminal neuralgia. Am J Surg 24:4474551934

  • 24

    Dellaretti MReyns NTouzet GSarrazin TDubois FLartigau E: Clinical outcomes after Gamma Knife surgery for idiopathic trigeminal neuralgia: review of 76 consecutive cases. J Neurosurg 109 Suppl:1731782008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Dhople AAAdams JRMaggio WWNaqvi SARegine WFKwok Y: Long-term outcomes of Gamma Knife radiosurgery for classic trigeminal neuralgia: implications of treatment and critical review of the literature. Clinical article. J Neurosurg 111:3513582009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Dos Santos MAPérez de Salcedo JBGutiérrez Diaz JANagore GCalvo FASamblás J: Outcome for patients with essential trigeminal neuralgia treated with linear accelerator stereotactic radiosurgery. Stereotact Funct Neurosurg 89:2202252011

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27

    Drzymala REMalyapa RSDowling JLRich KMSimpson JRMansur DB: Gamma knife radiosurgery for trigeminal neuralgia: the Washington University initial experience. Stereotact Funct Neurosurg 83:1481522005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Elaimy ALHanson PWLamoreaux WTMackay ARDemakas JJFairbanks RK: Clinical outcomes of gamma knife radiosurgery in the treatment of patients with trigeminal neuralgia. Int J Otolaryngol 2012:9191862012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Eller JLRaslan AMBurchiel KJ: Trigeminal neuralgia: definition and classification. Neurosurg Focus 18(5):E32005

  • 30

    Erbay SHBhadelia RARiesenburger RGupta PO’Callaghan MYun E: Association between neurovascular contact on MRI and response to gamma knife radiosurgery in trigeminal neuralgia. Neuroradiology 48:26302006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Fariselli LMarras CDe Santis MMarchetti MMilanesi IBroggi G: CyberKnife radiosurgery as a first treatment for idiopathic trigeminal neuralgia. Neurosurgery 64 (2 Suppl):A96A1012009

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32

    Flickinger JCPollock BEKondziolka DPhuong LKFoote RLStafford SL: Does increased nerve length within the treatment volume improve trigeminal neuralgia radiosurgery? A prospective double-blind, randomized study. Int J Radiat Oncol Biol Phys 51:4494542001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Flickinger JC JrKim HKano HGreenberger JSArai YNiranjan A: Do carbamazepine, gabapentin, or other anticonvulsants exert sufficient radioprotective effects to alter responses from trigeminal neuralgia radiosurgery? Int J Radiat Oncol Biol Phys 83:e501e5062012

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34

    Fountas KNLee GPSmith JR: Outcome of patients undergoing gamma knife stereotactic radiosurgery for medically refractory idiopathic trigeminal neuralgia: Medical College of Georgia’s experience. Stereotact Funct Neurosurg 84:88962006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Fountas KNSmith JRLee GPJenkins PDCantrell RRSheils WC: Gamma Knife stereotactic radiosurgical treatment of idiopathic trigeminal neuralgia: long-term outcome and complications. Neurosurg Focus 23(6):E82007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    Fraioli MFStrigari LFraioli CLecce MLisciani D: Preliminary results of 45 patients with trigeminal neuralgia treated with radiosurgery compared to hypofractionated stereotactic radiotherapy, using a dedicated linear accelerator. J Clin Neurosci 19:140114032012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Fransen P: Cost-effectiveness in the surgical treatments for trigeminal neuralgia. Acta Neurol Belg 112:2452472012

  • 38

    Friedman DPMorales REGoldman HW: Role of enhanced MRI in the follow-up of patients with medically refractory trigeminal neuralgia undergoing stereotactic radiosurgery using the gamma knife: initial experience. J Comput Assist Tomogr 25:7277322001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39

    Frighetto LDe Salles AASmith ZAGoss BSelch MSolberg T: Noninvasive linear accelerator radiosurgery as the primary treatment for trigeminal neuralgia. Neurology 62:6606622004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40

    Gorgulho ADe Salles AAMcArthur DAgazaryan NMedin PSolberg T: Brainstem and trigeminal nerve changes after radiosurgery for trigeminal pain. Surg Neurol 66:1271352006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41

    Gorgulho AADe Salles AA: Impact of radiosurgery on the surgical treatment of trigeminal neuralgia. Surg Neurol 66:3503562006

  • 42

    Goss BWFrighetto LDeSalles AASmith ZSolberg TSelch M: Linear accelerator radiosurgery using 90 gray for essential trigeminal neuralgia: results and dose volume histogram analysis. Neurosurgery 53:8238302003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43

    Han JHKim DGChung HTPaek SHKim YHKim CY: Long-term outcome of gamma knife radiosurgery for treatment of typical trigeminal neuralgia. Int J Radiat Oncol Biol Phys 75:8228272009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44

    Hayashi MChernov MTamura NTaira TIzawa MYomo S: Stereotactic radiosurgery of essential trigeminal neuralgia using Leksell Gamma Knife model C with automatic positioning system: technical nuances and evaluation of outcome in 130 patients with at least 2 years follow-up after treatment. Neurosurg Rev 34:4975082011

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 45

    Headache Classification Committee of the International Headache Society (IHS): The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia Int J Headache 33:6298082013

    • Search Google Scholar
    • Export Citation
  • 46

    Holland MNoeller JBuatti JHe WShivapour ETHitchon PW: The cost-effectiveness of surgery for trigeminal neuralgia in surgically naïve patients: a retrospective study. Clin Neurol Neurosurg 137:34372015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47

    Huang CFChiou SYWu MFTu HTLiu WS: Gamma Knife surgery for recurrent or residual trigeminal neuralgia after a failed initial procedure. J Neurosurg 113 Suppl:1721772010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48

    Huang CFTu HTLiu WSLin LY: Gamma Knife surgery for trigeminal pain caused by benign brain tumors. J Neurosurg 109 Suppl:1541592008

  • 49

    Huang CFTu HTLiu WSLin LY: Gamma Knife surgery used as primary and repeated treatment for idiopathic trigeminal neuralgia. J Neurosurg 109 Suppl:1791842008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50

    Jannetta PJ: Microsurgical management of trigeminal neuralgia. Arch Neurol 42:8001985

  • 51

    Jawahar AWadhwa RBerk CCaldito GDeLaune AAmpil F: Assessment of pain control, quality of life, and predictors of success after gamma knife surgery for the treatment of trigeminal neuralgia. Neurosurg Focus 18(5):E82005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 52

    Jorns TPZakrzewska JM: Evidence-based approach to the medical management of trigeminal neuralgia. Br J Neurosurg 21:2532612007

  • 53

    Kannan VDeopujari CEMisra BKShetty PGShroff MMPendse AM: Gamma-knife radiosurgery for trigeminal neuralgia. Australas Radiol 43:3393411999

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 54

    Kanner AANeyman GSuh JHWeinhous MSLee SYBarnett GH: Gamma knife radiosurgery for trigeminal neuralgia: comparing the use of a 4-mm versus concentric 4- and 8-mm collimators. Stereotact Funct Neurosurg 82:49572004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 55

    Kano HKondziolka DYang HCZorro OLobato-Polo JFlannery TJ: Outcome predictors after gamma knife radiosurgery for recurrent trigeminal neuralgia. Neurosurgery 67:163716452010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 56

    Kanpolat YSavas ABekar ABerk C: Percutaneous controlled radiofrequency trigeminal rhizotomy for the treatment of idiopathic trigeminal neuralgia: 25-year experience with 1,600 patients. Neurosurgery 48:5245342001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 57

    Karam SDTai AWooster MRashid AChen RBaig N: Trigeminal neuralgia treatment outcomes following Gamma Knife radiosurgery with a minimum 3-year follow-up. J Radiat Oncol 3:1251302014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 58

    Kim YHKim DGKim JWKim YHHan JHChung HT: Is it effective to raise the irradiation dose from 80 to 85 Gy in gamma knife radiosurgery for trigeminal neuralgia? Stereotact Funct Neurosurg 88:1691762010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 59

    Kondziolka DFlickinger JCLunsford LDHabeck M: Trigeminal neuralgia radiosurgery: the University of Pittsburgh experience. Stereotact Funct Neurosurg 66 (Suppl 1):3433481996

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 60

    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

    • Search Google Scholar
    • Export Citation
  • 61

    Kondziolka DLunsford LDFlickinger JCYoung RFVermeulen SDuma CM: Stereotactic radiosurgery for trigeminal neuralgia: a multiinstitutional study using the gamma unit. J Neurosurg 84:9409451996

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 62

    Kondziolka DPerez BFlickinger JCHabeck MLunsford LD: Gamma knife radiosurgery for trigeminal neuralgia: results and expectations. Arch Neurol 55:152415291998

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 63

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

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 64

    Kubicek GJHall WAOrner JBGerbi BJDusenbery KE: Long-term follow-up of trigeminal neuralgia treatment using a linear accelerator. Stererotact Funct Neurosurg 82:2442492004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 65

    Lazzara BMOrtiz OBordia RWitten MRHaas JAKatz AJ: Cyberknife radiosurgery in treating trigeminal neuralgia. J Neurointerv Surg 5:81852013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 66

    Lee JKChoi HJKo HCChoi SKLim YJ: Long term outcomes of gamma knife radiosurgery for typical trigeminal neuralgia-minimum 5-year follow-up. J Korean Neurosurg Soc 51:2762802012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 67

    Lee JKKim DRHuh YHKim JKNamgung WCHong SH: Long-term outcome of gamma knife surgery using a retrogasserian petrous bone target for classic trigeminal neuralgia. Acta Neurochir Suppl 116:1271352013

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 68

    Lee JYSandhu SMiller DSolberg TDorsey JFAlonso-Basanta M: Higher dose rate Gamma Knife radiosurgery may provide earlier and longer-lasting pain relief for patients with trigeminal neuralgia. J Neurosurg 123:9619682015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 69

    Leksell L: The stereotaxic method and radiosurgery of the brain. Acta Chir Scand 102:3163191951

  • 70

    Liang CLHo MWLu KTsai YDLiliang PCWang KW: An investigation of eye lens dose of stereotactic radiosurgery for trigeminal neuralgia using Leksell Gamma Knife model C. J Neurosurg 105 Suppl:1121162006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 71

    Lim MCotrutz CRomanelli PSchaal DGibbs IChang SD: Stereotactic radiosurgery using CT cisternography and non-isocentric planning for the treatment of trigeminal neuralgia. Comput Aided Surg 11:11202006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 72

    Lim MVillavicencio ATBurneikiene SChang SDRomanelli PMcNeely L: CyberKnife radiosurgery for idiopathic trigeminal neuralgia. Neurosurg Focus 18(5):E92005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 73

    Linskey MERatanatharathorn VPeñagaricano J: A prospective cohort study of microvascular decompression and Gamma Knife surgery in patients with trigeminal neuralgia. J Neurosurg 109 Suppl:1601722008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 74

    Little ASShetter AGShetter MEBay CRogers CL: Long-term pain response and quality of life in patients with typical trigeminal neuralgia treated with gamma knife stereotactic radiosurgery. Neurosurgery 63:9159242008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 75

    Little ASShetter AGShetter MEKakarla UKRogers CL: Salvage gamma knife stereotactic radiosurgery for surgically refractory trigeminal neuralgia. Int J Radiat Oncol Biol Phys 74:5225272009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 76

    Loescher ARRadatz MKemeny ARowe J: Stereotactic radiosurgery for trigeminal neuralgia: outcomes and complications. Br J Neurosurg 26:45522012

  • 77

    Longhi MRizzo PNicolato AForoni RReggio MGerosa M: Gamma knife radiosurgery for trigeminal neuralgia: results and potentially predictive parameters—part I: Idiopathic trigeminal neuralgia. Neurosurgery 61:125412612007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 78

    Lorenzoni JDavid PLevivier M: MR-based follow-up of the superior cerebellar artery after radiosurgery for trigeminal neuralgia. Clin Neurol Neurosurg 113:7587612011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 79

    Love SCoakham HB: Trigeminal neuralgia: pathology and pathogenesis. Brain 124:234723602001

  • 80

    Lucas JT JrNida AMIsom SMarshall KBourland JDLaxton AW: Predictive nomogram for the durability of pain relief from Gamma Knife radiation surgery in the treatment of trigeminal neuralgia. Int J Radiat Oncol Biol Phys 89:1201262014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 81

    Ma LChin LSarfaraz MShepard DYu C: An investigation of eye lens dose for Gamma Knife treatments of trigeminal neuralgia. J Appl Clin Med Phys 1:1161192000

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 82

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

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 83

    Marshall KChan MDMcCoy TPAubuchon ACBourland JDMcMullen KP: Predictive variables for the successful treatment of trigeminal neuralgia with gamma knife radiosurgery. Neurosurgery 70:5665732012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 84

    Massager NAbeloos LDevriendt DOp de Beeck MLevivier M: Clinical evaluation of targeting accuracy of gamma knife radio surgery in trigeminal neuralgia. Int J Radiat Oncol Biol Phys 69:151415202007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 85

    Massager NLorenzoni JDevriendt DDesmedt FBrotchi JLevivier M: Gamma knife surgery for idiopathic trigeminal neuralgia performed using a far-anterior cisternal target and a high dose of radiation. J Neurosurg 100:5976052004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 86

    Massager NMurata NTamura MDevriendt DLevivier MRégis J: Influence of nerve radiation dose in the incidence of trigeminal dysfunction after trigeminal neuralgia radiosurgery. Neurosurgery 60:6816882007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 87

    Massager NNissim OMurata NDevriendt DDesmedt FVanderlinden B: Effect of beam channel plugging on the outcome of gamma knife radiosurgery for trigeminal neuralgia. Int J Radiat Oncol Biol Phys 65:120012052006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 88

    Matsuda SSerizawa TNagano OOno J: Comparison of the results of 2 targeting methods in Gamma Knife surgery for trigeminal neuralgia. J Neurosurg 109 Suppl:1851892008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 89

    Matsuda SSerizawa TSato MOno J: Gamma knife radiosurgery for trigeminal neuralgia: the dry-eye complication. J Neurosurg 97 (5 Suppl):5255282002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 90

    McNatt SAYu CGiannotta SLZee CSApuzzo MLPetrovich Z: Gamma knife radiosurgery for trigeminal neuralgia. Neurosurgery 56:129513032005

  • 91

    Mousavi SHNiranjan AHuang MJLaghari FJShin SSMindlin JL: Early radiosurgery provides superior pain relief for trigeminal neuralgia patients. Neurology 85:215921652015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 92

    Nanda AJavalkar VZhang SAhmed O: Long term efficacy and patient satisfaction of microvascular decompression and gamma knife radiosurgery for trigeminal neuralgia. J Clin Neurosci 22:8188222015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 93

    North RBKidd DHPiantadosi SCarson BS: Percutaneous retrogasserian glycerol rhizotomy. Predictors of success and failure in treatment of trigeminal neuralgia. J Neurosurg 72:8518561990

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 94

    Oh IHChoi SKPark BJKim TSRhee BALim YJ: The treatment outcome of elderly patients with idiopathic trigeminal neuralgia: micro-vascular decompression versus Gamma knife radiosurgery. J Korean Neurosurg Soc 44:1992042008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 95

    Pan HCSheehan JHuang CFSheu MLYang DYChiu WT: Quality-of-life outcomes after Gamma Knife surgery for trigeminal neuralgia. J Neurosurg 113 Suppl:1911982010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 96

    Park KJKano HBerkowitz OAwan NRFlickinger JCLunsford LD: Computed tomography-guided gamma knife stereotactic radiosurgery for trigeminal neuralgia. Acta Neurochir (Wien) 153:160116092011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 97

    Park KJKondziolka DKano HBerkowitz OAhmed SFLiu X: Outcomes of Gamma Knife surgery for trigeminal neuralgia secondary to vertebrobasilar ectasia. J Neurosurg 116:73812012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 98

    Park SHHwang SK: Outcomes of gamma knife radiosurgery for trigeminal neuralgia after a minimum 3-year follow-up. J Clin Neurosci 18:6456482011

  • 99

    Park SHHwang SKKang DHPark JHwang JHSung JK: The retrogasserian zone versus dorsal root entry zone: comparison of two targeting techniques of gamma knife radiosurgery for trigeminal neuralgia. Acta Neurochir (Wien) 152:116511702010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 100

    Park YSKim JPChang WSKim HYPark YGChang JW: Gamma knife radiosurgery for idiopathic trigeminal neuralgia as primary vs. secondary treatment option. Clin Neurol Neurosurg 113:4474522011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 101

    Parmar MKTorri VStewart L: Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Stat Med 17:281528341998

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 102

    Peddada AVSceats DJWhite GABulz GGibbs GLSwitzer B: CyberKnife radiosurgery for trigeminal neuralgia: unanticipated iatrogenic effect following successful treatment. J Neurosurg 115:9409442011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 103

    Petit JHHerman JMNagda SDiBiase SJChin LS: Radiosurgical treatment of trigeminal neuralgia: evaluating quality of life and treatment outcomes. Int J Radiat Oncol Biol Phys 56:114711532003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 104

    Pollock BE: Comparison of posterior fossa exploration and stereotactic radiosurgery in patients with previously nonsurgically treated idiopathic trigeminal neuralgia. Neurosurg Focus 18(5):E62005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 105

    Pollock BEEcker RD: A prospective cost-effectiveness study of trigeminal neuralgia surgery. Clin J Pain 21:3173222005

  • 106

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

  • 107

    Pollock BESchoeberl KA: Prospective comparison of posterior fossa exploration and stereotactic radiosurgery dorsal root entry zone target as primary surgery for patients with idiopathic trigeminal neuralgia. Neurosurgery 67:6336392010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 108

    Pusztaszeri MVillemure JGRegli LDo HPPica A: Radiosurgery for trigeminal neuralgia using a linear accelerator with BrainLab system: report on initial experience in Lausanne, Switzerland. Swiss Med Wkly 137:6826862007

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 109

    Rand RWJacques DBMelbye RWCopcutt BGLevenick MNFisher MR: Leksell Gamma Knife treatment of tic douloureux. Stereotact Funct Neurosurg 61 (Suppl 1):931021993

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 110

    Régis JCarron RTuleasca CDonnet A: Distal radiosurgical targeting for trigeminal neuralgia in Sheehan JGerszten P (eds): Controversies in Stereotactic Radiosurgery: Best Evidence Recommendations. New York: Thieme2014 pp 120130

    • Search Google Scholar
    • Export Citation
  • 111

    Régis JManera LDufour HPorcheron DSedan RPeragut JC: Effects of the Gamma Knife trigeminal neuralgia. Stereotact Funct Neurosurg 64 (Suppl 1):1821921995

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 112

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

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 113

    Régis JTuleasca C: Fifteen years of Gamma Knife surgery for trigeminal neuralgia in the Journal of Neurosurgery: history of a revolution in functional neurosurgery. J Neurosurg 115 Suppl:272011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 114

    Régis JTuleasca CResseguier NCarron RDonnet AGaudart J: Long-term safety and efficacy of Gamma Knife surgery in classical trigeminal neuralgia: a 497-patient historical cohort study. J Neurosurg 124:107910872016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 115

    Régis JTuleasca CResseguier NCarron RDonnet AYomo S: The very long-term outcome of radiosurgery for classical trigeminal neuralgia. Stereotact Funct Neurosurg 94:24322016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 116

    Richards GMBradley KATomé WABentzen SMResnick DKMehta MP: Linear accelerator radiosurgery for trigeminal neuralgia. Neurosurgery 57:119312002005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 117

    Riesenburger RIHwang SWSchirmer CMZerris VWu JKMahn K: Outcomes following single-treatment Gamma Knife surgery for trigeminal neuralgia with a minimum 3-year follow-up. J Neurosurg 112:7667712010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 118

    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

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 119

    Romanelli PHeit GChang SDMartin DPham CAdler J: Cyberknife radiosurgery for trigeminal neuralgia. Stereotact Funct Neurosurg 81:1051092003

  • 120

    Shaya MJawahar ACaldito GSin AWillis BKNanda A: Gamma knife radiosurgery for trigeminal neuralgia: a study of predictors of success, efficacy, safety, and outcome at LSUHSC. Surg Neurol 61:5295342004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 121

    Sheehan JPan HCStroila MSteiner L: Gamma knife surgery for trigeminal neuralgia: outcomes and prognostic factors. J Neurosurg 102:4344412005

  • 122

    Sheehan JPRay DKMonteith SYen CPLesnick JKersh R: Gamma Knife radiosurgery for trigeminal neuralgia: the impact of magnetic resonance imaging-detected vascular impingement of the affected nerve. J Neurosurg 113:53582010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 123

    Sivakanthan SVan Gompel JJAlikhani Pvan Loveren HChen RAgazzi S: Surgical management of trigeminal neuralgia: use and cost-effectiveness from an analysis of the Medicare Claims Database. Neurosurgery 75:2202262014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 124

    Smith ZADe Salles AAFrighetto LGoss BLee SPSelch M: Dedicated linear accelerator radiosurgery for the treatment of trigeminal neuralgia. J Neurosurg 99:5115162003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 125

    Smith ZAGorgulho AABezrukiy NMcArthur DAgazaryan NSelch MT: Dedicated linear accelerator radiosurgery for trigeminal neuralgia: a single-center experience in 179 patients with varied dose prescriptions and treatment plans. Int J Radiat Oncol Biol Phys 81:2252312011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 126

    Soboleva OIGolanov AVGorlachev GEGalkin MVKadasheva ABAntipina NA: [CyberKnife stereotactic radiosurgery in the treatment of patients with trigeminal neuralgia.] Zh Vopr Neirokhir Im N N Burdenko 76:79842012

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 127

    Somaza SHurtado WMontilla EGhaleb J: Gamma knife radiosurgery to the trigeminal ganglion for treatment of trigeminal neuralgia secondary to vertebrobasilar ectasia. Surg Neurol Int 5 (Suppl 16):S580S5852014

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 128

    Szeifert GTSalmon ILorenzoni JMassager NLevivier M: Pathological findings following trigeminal neuralgia radiosurgery. Prog Neurol Surg 20:2442482007

  • 129

    Tang CTChang SDTseng KYLiu MYJu DT: CyberKnife stereotactic radiosurgical rhizotomy for refractory trigeminal neuralgia. J Clin Neurosci 18:144914532011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 130

    Tang XWu HWang BZhang NDong YDing J: A new classification and clinical results of Gamma Knife radiosurgery for cavernous sinus hemangiomas: a report of 53 cases. Acta Neurochir (Wien) 157:9619692015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 131

    Tarricone RAguzzi GMusi FFariselli LCasasco A: Cost-effectiveness analysis for trigeminal neuralgia: Cyberknife vs microvascular decompression. Neuropsychiatr Dis Treat 4:6476522008

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 132

    Tawk RGDuffy-Fronckowiak MScott BEAlberico RADiaz AZPodgorsak MB: Stereotactic gamma knife surgery for trigeminal neuralgia: detailed analysis of treatment response. J Neurosurg 102:4424492005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 133

    Tuleasca CCarron RResseguier NDonnet ARoussel PGaudart J: Decreased probability of initial pain cessation in classical trigeminal neuralgia treated with Gamma Knife surgery in case of previous microvascular decompression: a prospective series of 45 patients with >1 year of follow-up. Neurosurgery 77:87952015

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 134

    Tuleasca CCarron RResseguier NDonnet ARoussel PGaudart J: Patterns of pain-free response in 497 cases of classic trigeminal neuralgia treated with Gamma Knife surgery and followed up for least 1 year. J Neurosurg 117 Suppl:1811882012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 135

    Tuleasca CCarron RResseguier NDonnet ARoussel PGaudart J: Trigeminal neuralgia related to megadolichobasilar artery compression: a prospective series of twenty-nine patients treated with Gamma Knife surgery, with more than one year of follow-up. Stereotact Funct Neurosurg 92:1701772014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 136

    Urgosik DLiscak RNovotny J JrVymazal JVladyka V: Treatment of essential trigeminal neuralgia with gamma knife surgery. J Neurosurg 102 Suppl:29332005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 137

    Verheul JBHanssens PELie STLeenstra SPiersma HBeute GN: Gamma Knife surgery for trigeminal neuralgia: a review of 450 consecutive cases. J Neurosurg 113 Suppl:1601672010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 138

    Villavicencio ATLim MBurneikiene SRomanelli PAdler JRMcNeely L: Cyberknife radiosurgery for trigeminal neuralgia treatment: a preliminary multicenter experience. Neurosurgery 62:6476552008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 139

    Wiffen PJMcQuay HJMoore RA: Carbamazepine for acute and chronic pain. Cochrane Database Syst Rev (3):CD0054512005

  • 140

    Worthington CHutson KBoulware RNeglia WGibbons JPClark R: Computerized tomography cisternography of the trigeminal nerve for stereotactic radiosurgery. Case report. J Neurosurg 93 (Suppl 3):1691712000

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 141

    Xu ZSchlesinger DMoldovan KPrzybylowski CSun XLee CC: Impact of target location on the response of trigeminal neuralgia to stereotactic radiosurgery. J Neurosurg 120:7167242014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 142

    Xue JGoldman HWGrimm JLaCouture TChen YHughes L: Dose-volume effects on brainstem dose tolerance in radiosurgery. J Neurosurg 117 Suppl:1891962012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 143

    Yatshushiro KNakamura KTomosugi TFujimoto TKuratsu J: Cerebellar infarction with superior cerebellar artery occlusion after Gamma Knife radiosurgery for trigeminal neuralgia: case report, in 6th International Stereotactic Radiosurgery Society Congress. Marseille: ISRS2003 (Abstract)

    • Export Citation
  • 144

    Young BShivazad AKryscio RJSt Clair WBush HM: Long-term outcome of high-dose Gamma Knife surgery in treatment of trigeminal neuralgia. J Neurosurg 119:116611752013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 145

    Young RFVermeulen SSGrimm PBlasko JPosewitz A: Gamma Knife radiosurgery for treatment of trigeminal neuralgia: idiopathic and tumor related. Neurology 48:6086141997

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 146

    Zahra HThe BSPaulino ACYoshor DTrask TBaskin D: Stereotactic radiosurgery for trigeminal neuralgia utilizing the BrainLAB Novalis system. Technol Cancer Res Treat 8:4074122009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 147

    Zakrzewska JMLopez BC: Quality of reporting in evaluations of surgical treatment of trigeminal neuralgia: recommendations for future reports. Neurosurgery 53:1101222003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 148

    Zhao ZFYang LZJiang CLZheng YRZhang JW: Gamma Knife irradiation-induced histopathological changes in the trigeminal nerves of rhesus monkeys. J Neurosurg 113:39442010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 149

    Zheng LGXu DSKang CSZhang ZYLi YHZhang YP: Stereotactic radiosurgery for primary trigeminal neuralgia using the Leksell Gamma unit. Stereotact Funct Neurosurg 76:29352001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 989 989 68
Full Text Views 357 357 18
PDF Downloads 282 282 21
EPUB Downloads 0 0 0

PubMed

Google Scholar