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Gamma knife radiosurgery for trigeminal neuralgia: a study of predictors of success, efficacy, safety, and outcome at LSUHSC.
Surg Neurol. 2004 Jun; 61(6):529-34; discussion 534-5.SN

Abstract

BACKGROUND

Trigeminal neuralgia (TN) is a painful condition of controversial origin; however, vascular compression of the root entry zone of the trigeminal nerve is thought to be responsible in some cases. Recently, stereotactic radiosurgery has been established as an alternative treatment for medically intractable TN.

METHODS

Forty patients with medically refractory TN underwent gamma knife surgery for pain control at our institution. Dose planning was based on high-resolution, contrast-enhanced, axial, volume acquisition magnetic resonance images. Images were reviewed to detect vascular compression of the trigeminal nerve at the root entry zone by an observer blinded to the affected side and the outcome. Another observer, blinded to radiologic findings, conducted the patient follow-up. Results were classified as excellent and good (favorable outcomes) and failure (unfavorable) based upon the intensity of pain, frequency of episodes, pain medications, and need for additional interventions after radiosurgery.

RESULTS

Pain was left-sided in 22 patients and right-sided in 18 patients. Vascular compression of the affected nerve at the root entry zone was demonstrable in 14 patients. Prescription dose ranged from 70 to 90 Gy. At a median follow-up of 14 months (range, 3-31 months), 16 patients (40%) had excellent pain control, 12 (30%) had good control, while 12 (30%) had failed treatment. The Kaplan-Meier actuarial pain control rate at 15 months was 82.25 +/- 0.8% (95%CI). Magnetic resonance detectable vascular compression did not affect the outcome (p = 0.6). Increasing marginal dose (> or =40Gy) was a significant predictor of favorable outcome (p = 0.015).

CONCLUSIONS

gamma knife surgery is an effective and safe treatment for TN. In our study, we found that vascular compression of the nerve at the root entry zone was not a predictor of the outcome of gamma surgery for TN. The outcome improves with marginal prescription dose of 80 Gy or higher.

Authors+Show Affiliations

Shaya M
Department of Neurosurgery, Louisiana State University Health Sciences Center in Shreveport, 71130, USA.
Jawahar A
No affiliation info available
Caldito G
No affiliation info available
Sin A
No affiliation info available
Willis BK
No affiliation info available
Nanda A
No affiliation info available

MeSH

AdultAgedAged, 80 and overBrainFemaleFollow-Up StudiesHumansMagnetic Resonance ImagingMaleMiddle AgedPain MeasurementRadiosurgeryRetrospective StudiesSeverity of Illness IndexTreatment OutcomeTrigeminal Neuralgia

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15165787

Citation

Shaya, Mark, et al. "Gamma Knife Radiosurgery for Trigeminal Neuralgia: a Study of Predictors of Success, Efficacy, Safety, and Outcome at LSUHSC." Surgical Neurology, vol. 61, no. 6, 2004, pp. 529-34; discussion 534-5.
Shaya M, Jawahar A, Caldito G, et al. Gamma knife radiosurgery for trigeminal neuralgia: a study of predictors of success, efficacy, safety, and outcome at LSUHSC. Surg Neurol. 2004;61(6):529-34; discussion 534-5.
Shaya, M., Jawahar, A., Caldito, G., Sin, A., Willis, B. K., & Nanda, A. (2004). Gamma knife radiosurgery for trigeminal neuralgia: a study of predictors of success, efficacy, safety, and outcome at LSUHSC. Surgical Neurology, 61(6), 529-34; discussion 534-5.
Shaya M, et al. Gamma Knife Radiosurgery for Trigeminal Neuralgia: a Study of Predictors of Success, Efficacy, Safety, and Outcome at LSUHSC. Surg Neurol. 2004;61(6):529-34; discussion 534-5. PubMed PMID: 15165787.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gamma knife radiosurgery for trigeminal neuralgia: a study of predictors of success, efficacy, safety, and outcome at LSUHSC. AU - Shaya,Mark, AU - Jawahar,Ajay, AU - Caldito,Gloria, AU - Sin,Anthony, AU - Willis,Brian K, AU - Nanda,Anil, PY - 2003/07/28/received PY - 2003/11/18/accepted PY - 2004/5/29/pubmed PY - 2004/6/18/medline PY - 2004/5/29/entrez SP - 529-34; discussion 534-5 JF - Surgical neurology JO - Surg Neurol VL - 61 IS - 6 N2 - BACKGROUND: Trigeminal neuralgia (TN) is a painful condition of controversial origin; however, vascular compression of the root entry zone of the trigeminal nerve is thought to be responsible in some cases. Recently, stereotactic radiosurgery has been established as an alternative treatment for medically intractable TN. METHODS: Forty patients with medically refractory TN underwent gamma knife surgery for pain control at our institution. Dose planning was based on high-resolution, contrast-enhanced, axial, volume acquisition magnetic resonance images. Images were reviewed to detect vascular compression of the trigeminal nerve at the root entry zone by an observer blinded to the affected side and the outcome. Another observer, blinded to radiologic findings, conducted the patient follow-up. Results were classified as excellent and good (favorable outcomes) and failure (unfavorable) based upon the intensity of pain, frequency of episodes, pain medications, and need for additional interventions after radiosurgery. RESULTS: Pain was left-sided in 22 patients and right-sided in 18 patients. Vascular compression of the affected nerve at the root entry zone was demonstrable in 14 patients. Prescription dose ranged from 70 to 90 Gy. At a median follow-up of 14 months (range, 3-31 months), 16 patients (40%) had excellent pain control, 12 (30%) had good control, while 12 (30%) had failed treatment. The Kaplan-Meier actuarial pain control rate at 15 months was 82.25 +/- 0.8% (95%CI). Magnetic resonance detectable vascular compression did not affect the outcome (p = 0.6). Increasing marginal dose (> or =40Gy) was a significant predictor of favorable outcome (p = 0.015). CONCLUSIONS: gamma knife surgery is an effective and safe treatment for TN. In our study, we found that vascular compression of the nerve at the root entry zone was not a predictor of the outcome of gamma surgery for TN. The outcome improves with marginal prescription dose of 80 Gy or higher. SN - 0090-3019 UR - https://www.unboundmedicine.com/medline/citation/15165787/Gamma_knife_radiosurgery_for_trigeminal_neuralgia:_a_study_of_predictors_of_success_efficacy_safety_and_outcome_at_LSUHSC_ DB - PRIME DP - Unbound Medicine ER -