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Gamma knife radiosurgery for multiple sclerosis-related trigeminal neuralgia.
Neurology. 2009 Oct 06; 73(14):1149-54.Neur

Abstract

BACKGROUND

Surgical options for multiple sclerosis (MS) related to trigeminal neuralgia (TN), a severe and disabling pain disorder, include percutaneous rhizotomy, stereotactic radiosurgery, or microsurgical nerve section. Our goal was to evaluate clinical outcomes after gamma knife radiosurgery (GKRS) in patients with MS with TN.

METHODS

We evaluated clinical outcomes in 37 patients with TN managed over a 12-year period. The maximum TN target dose varied between 70 and 90 Gy. Seventy-eight percent of patients had failed prior surgery. In 9, GKRS was the first procedure. Median follow-up was 56.7 months (range, 6-174). Pain relief was assessed in each patient by physicians who did not participate in the surgery.

RESULTS

Eventual complete pain relief (BNI grade I) after GKRS and reasonable pain control (BNI grade I-IIIb) after GKRS were noted in 23 patients (62.1%) and 36 patients (97.3%) at some point in their course. Reasonable pain control (BNI grade I-IIIb) after GKRS was maintained in 82.6%, 73.9%, and 54.0% of patients after 1, 3, and 5 years. Fourteen patients (37.8%) underwent a second or a subsequent procedure for residual or recurrent pain. Eight patients underwent a second GKRS, 5 underwent percutaneous glycerol rhizotomy, and 1 underwent balloon microcompression. The complication rate after GKRS was 5.4% (new onset of nondisabling paresthesias). No patient developed dysesthesias.

CONCLUSIONS

Gamma knife radiosurgery is the most minimally invasive surgical technique for multiple sclerosis-related trigeminal neuralgia and has low morbidity. For this reason, gamma knife radiosurgery proved to be a satisfactory management strategy for multiple sclerosis-related trigeminal neuralgia.

Authors+Show Affiliations

Department of Neurological Surgery, University of Pittsburgh School of Medicine, PA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19805732

Citation

Zorro, O, et al. "Gamma Knife Radiosurgery for Multiple Sclerosis-related Trigeminal Neuralgia." Neurology, vol. 73, no. 14, 2009, pp. 1149-54.
Zorro O, Lobato-Polo J, Kano H, et al. Gamma knife radiosurgery for multiple sclerosis-related trigeminal neuralgia. Neurology. 2009;73(14):1149-54.
Zorro, O., Lobato-Polo, J., Kano, H., Flickinger, J. C., Lunsford, L. D., & Kondziolka, D. (2009). Gamma knife radiosurgery for multiple sclerosis-related trigeminal neuralgia. Neurology, 73(14), 1149-54. https://doi.org/10.1212/WNL.0b013e3181bacfb4
Zorro O, et al. Gamma Knife Radiosurgery for Multiple Sclerosis-related Trigeminal Neuralgia. Neurology. 2009 Oct 6;73(14):1149-54. PubMed PMID: 19805732.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gamma knife radiosurgery for multiple sclerosis-related trigeminal neuralgia. AU - Zorro,O, AU - Lobato-Polo,J, AU - Kano,H, AU - Flickinger,J C, AU - Lunsford,L D, AU - Kondziolka,D, PY - 2009/10/7/entrez PY - 2009/10/7/pubmed PY - 2009/10/31/medline SP - 1149 EP - 54 JF - Neurology JO - Neurology VL - 73 IS - 14 N2 - BACKGROUND: Surgical options for multiple sclerosis (MS) related to trigeminal neuralgia (TN), a severe and disabling pain disorder, include percutaneous rhizotomy, stereotactic radiosurgery, or microsurgical nerve section. Our goal was to evaluate clinical outcomes after gamma knife radiosurgery (GKRS) in patients with MS with TN. METHODS: We evaluated clinical outcomes in 37 patients with TN managed over a 12-year period. The maximum TN target dose varied between 70 and 90 Gy. Seventy-eight percent of patients had failed prior surgery. In 9, GKRS was the first procedure. Median follow-up was 56.7 months (range, 6-174). Pain relief was assessed in each patient by physicians who did not participate in the surgery. RESULTS: Eventual complete pain relief (BNI grade I) after GKRS and reasonable pain control (BNI grade I-IIIb) after GKRS were noted in 23 patients (62.1%) and 36 patients (97.3%) at some point in their course. Reasonable pain control (BNI grade I-IIIb) after GKRS was maintained in 82.6%, 73.9%, and 54.0% of patients after 1, 3, and 5 years. Fourteen patients (37.8%) underwent a second or a subsequent procedure for residual or recurrent pain. Eight patients underwent a second GKRS, 5 underwent percutaneous glycerol rhizotomy, and 1 underwent balloon microcompression. The complication rate after GKRS was 5.4% (new onset of nondisabling paresthesias). No patient developed dysesthesias. CONCLUSIONS: Gamma knife radiosurgery is the most minimally invasive surgical technique for multiple sclerosis-related trigeminal neuralgia and has low morbidity. For this reason, gamma knife radiosurgery proved to be a satisfactory management strategy for multiple sclerosis-related trigeminal neuralgia. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/19805732/Gamma_knife_radiosurgery_for_multiple_sclerosis_related_trigeminal_neuralgia_ DB - PRIME DP - Unbound Medicine ER -