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Gamma Knife surgery for recurrent or residual trigeminal neuralgia after a failed initial procedure.
J Neurosurg. 2010 Dec; 113 Suppl:172-7.JN

Abstract

OBJECT

The purpose of this study was to assess outcomes of Gamma Knife surgery (GKS) as a second treatment for recurrent or residual trigeminal neuralgia (TN) after failure of 3 initial procedures: microvascular decompression (MVD), GKS, and percutaneous radiofrequency rhizotomy (PRR).

METHODS

Between 1999 and 2008, 65 patients (31 men [48%] and 34 women [52%]) with recurrent TN were treated with GKS. All 65 patients had undergone previous medical procedures that failed to achieve sufficient pain relief: 27 patients (42%) had undergone MVD, 8 (12%) had undergone PRR, and 30 (46%) had undergone GKS as the initial treatment. The entry zone of the trigeminal nerve was targeted using a 4-mm collimator and treated with 35-90 Gy. The isocenter was positioned so that the brainstem surface was usually irradiated at an isodose no greater than 20% (59 patients) to 30% (6 patients). The median duration of TN symptoms in these patients was 39 months (range 1-192 months).

RESULTS

At the clinical evaluation, 42 patients (65%) with idiopathic TN reported successful pain control at a median follow-up point of 64 months (range 18-132 months). Of these patients, 33 (51%) were no longer using medication. At the 1-, 2-, and 3-year follow-up examinations, 74%, 71%, and 66% of patients experienced successful pain control, respectively. There was no significant difference in pain relief in the initial MVD group compared with the initial GKS and initial PRR groups (74% vs 59% and 50%, respectively; p = 0.342). Recurrence of pain was noted in 23 patients. Twelve of these 23 patients underwent another GKS, resulting in pain control in 8 patients (67%); 8 other patients underwent MVD, resulting in pain relief in 7 patients (87.5%). The median time from GKS to pain recurrence was 7 months (range 3-48 months). There was no significant difference in new facial numbness among the 3 groups (p = 0.24); however, in the initial GKS group, facial numbness was significantly associated with freedom from pain (p = 0.0012). There was a significant correlation between the total radiation dose and facial numbness. The cutoff value for facial numbness ranged from 115 to 120 Gy (p = 0.037).

CONCLUSIONS

Gamma Knife surgery as a second treatment achieved acceptable levels of pain control in 65% of patients with residual or recurrent TN after long-term follow-up. Initial treatment was not a factor that affected pain control, but salvage surgery may be considered separately for each group.

Authors+Show Affiliations

Gamma Knife Center, Chung-Shan Medical University Hospital and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan. gk@csh.org.twNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21121799

Citation

Huang, Chuan-Fu, et al. "Gamma Knife Surgery for Recurrent or Residual Trigeminal Neuralgia After a Failed Initial Procedure." Journal of Neurosurgery, vol. 113 Suppl, 2010, pp. 172-7.
Huang CF, Chiou SY, Wu MF, et al. Gamma Knife surgery for recurrent or residual trigeminal neuralgia after a failed initial procedure. J Neurosurg. 2010;113 Suppl:172-7.
Huang, C. F., Chiou, S. Y., Wu, M. F., Tu, H. T., & Liu, W. S. (2010). Gamma Knife surgery for recurrent or residual trigeminal neuralgia after a failed initial procedure. Journal of Neurosurgery, 113 Suppl, 172-7.
Huang CF, et al. Gamma Knife Surgery for Recurrent or Residual Trigeminal Neuralgia After a Failed Initial Procedure. J Neurosurg. 2010;113 Suppl:172-7. PubMed PMID: 21121799.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gamma Knife surgery for recurrent or residual trigeminal neuralgia after a failed initial procedure. AU - Huang,Chuan-Fu, AU - Chiou,Shyh-Ying, AU - Wu,Ming-Fang, AU - Tu,Hsien-Tang, AU - Liu,Wen-Shan, PY - 2010/12/3/entrez PY - 2010/12/9/pubmed PY - 2011/1/8/medline SP - 172 EP - 7 JF - Journal of neurosurgery JO - J Neurosurg VL - 113 Suppl N2 - OBJECT: The purpose of this study was to assess outcomes of Gamma Knife surgery (GKS) as a second treatment for recurrent or residual trigeminal neuralgia (TN) after failure of 3 initial procedures: microvascular decompression (MVD), GKS, and percutaneous radiofrequency rhizotomy (PRR). METHODS: Between 1999 and 2008, 65 patients (31 men [48%] and 34 women [52%]) with recurrent TN were treated with GKS. All 65 patients had undergone previous medical procedures that failed to achieve sufficient pain relief: 27 patients (42%) had undergone MVD, 8 (12%) had undergone PRR, and 30 (46%) had undergone GKS as the initial treatment. The entry zone of the trigeminal nerve was targeted using a 4-mm collimator and treated with 35-90 Gy. The isocenter was positioned so that the brainstem surface was usually irradiated at an isodose no greater than 20% (59 patients) to 30% (6 patients). The median duration of TN symptoms in these patients was 39 months (range 1-192 months). RESULTS: At the clinical evaluation, 42 patients (65%) with idiopathic TN reported successful pain control at a median follow-up point of 64 months (range 18-132 months). Of these patients, 33 (51%) were no longer using medication. At the 1-, 2-, and 3-year follow-up examinations, 74%, 71%, and 66% of patients experienced successful pain control, respectively. There was no significant difference in pain relief in the initial MVD group compared with the initial GKS and initial PRR groups (74% vs 59% and 50%, respectively; p = 0.342). Recurrence of pain was noted in 23 patients. Twelve of these 23 patients underwent another GKS, resulting in pain control in 8 patients (67%); 8 other patients underwent MVD, resulting in pain relief in 7 patients (87.5%). The median time from GKS to pain recurrence was 7 months (range 3-48 months). There was no significant difference in new facial numbness among the 3 groups (p = 0.24); however, in the initial GKS group, facial numbness was significantly associated with freedom from pain (p = 0.0012). There was a significant correlation between the total radiation dose and facial numbness. The cutoff value for facial numbness ranged from 115 to 120 Gy (p = 0.037). CONCLUSIONS: Gamma Knife surgery as a second treatment achieved acceptable levels of pain control in 65% of patients with residual or recurrent TN after long-term follow-up. Initial treatment was not a factor that affected pain control, but salvage surgery may be considered separately for each group. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/21121799/Gamma_Knife_surgery_for_recurrent_or_residual_trigeminal_neuralgia_after_a_failed_initial_procedure_ L2 - https://thejns.org/doi/10.3171/2010.8.GKS10915 DB - PRIME DP - Unbound Medicine ER -