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Comparative study of Gamma Knife surgery and percutaneous retrogasserian glycerol rhizotomy for trigeminal neuralgia in patients with multiple sclerosis.
J Neurosurg. 2012 Dec; 117 Suppl:175-80.JN

Abstract

OBJECT

Among patients with multiple sclerosis (MS) there is a high incidence of trigeminal neuralgia (TN), and outcomes after treatment seem inferior to those in patients suffering from idiopathic TN. The goal of this study was to evaluate clinical outcomes in patients with MS-related TN after Gamma Knife surgery (GKS) and compare them with those obtained using percutaneous retrogasserian glycerol rhizotomy (PRGR).

METHODS

The authors retrospectively reviewed the charts of 45 patients with MS-related TN. The first procedure undertaken was GKS in 27 patients and PRGR in 18 patients. Pain had been present for a median of 60 months (range 12-276 months) in patients who underwent GKS and 48 months (range 12-240 months) in patients who underwent PRGR. The following outcome measures were assessed in both groups of patients: pain relief (using the Barrow Neurological Institute [BNI] Pain Scale), procedure-related morbidity, time to pain relief and recurrence, and subsequent procedures that were performed.

RESULTS

The median duration of follow-up was 39 months (range 13-69 months) in the GKS group and 38 months (range 2-75 months) in the PRGR group. Reasonable pain control (BNI Pain Scale Scores I-IIIb) was noted in 22 patients (81.5%) who underwent GKS and in 18 patients (100%) who underwent PRGR. For patients who underwent GKS, the median time to pain relief was 6 months; for those who underwent PRGR, pain relief was immediate. In the GKS group 12 patients required subsequent procedures (3 patients for absence of response and 9 patients for pain recurrence), whereas in the PRGR group 6 patients required subsequent procedures (all for pain recurrence). As of the last follow-up, complete or reasonable pain control was finally achieved in 23 patients (85.2%) in the GKS group and in 16 patients (88.9%) in the PRGR group. The morbidity rate was 22.2% in the GKS group (all due to sensory loss and paresthesia) and 66.7% in the PRGR group (mostly hypalgesia, with 2 patients having corneal reflex loss and 1 patient suffering from meningitis).

CONCLUSIONS

Both GKS and PRGR are satisfactory strategies for treating MS-related TN. Gamma Knife surgery has a lower rate of sensory and overall morbidity than PRGR, but requires a delay before pain relief occurs. The authors propose that patients with extreme pain in need of fast relief should undergo PRGR. For other patients, both management strategies can lead to satisfactory pain relief, and the choice should be made based on patient preference and expectations.

Authors+Show Affiliations

Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada. david.mathieu@usherbrooke.caNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

23205807

Citation

Mathieu, David, et al. "Comparative Study of Gamma Knife Surgery and Percutaneous Retrogasserian Glycerol Rhizotomy for Trigeminal Neuralgia in Patients With Multiple Sclerosis." Journal of Neurosurgery, vol. 117 Suppl, 2012, pp. 175-80.
Mathieu D, Effendi K, Blanchard J, et al. Comparative study of Gamma Knife surgery and percutaneous retrogasserian glycerol rhizotomy for trigeminal neuralgia in patients with multiple sclerosis. J Neurosurg. 2012;117 Suppl:175-80.
Mathieu, D., Effendi, K., Blanchard, J., & Séguin, M. (2012). Comparative study of Gamma Knife surgery and percutaneous retrogasserian glycerol rhizotomy for trigeminal neuralgia in patients with multiple sclerosis. Journal of Neurosurgery, 117 Suppl, 175-80. https://doi.org/10.3171/2012.6.GKS12987
Mathieu D, et al. Comparative Study of Gamma Knife Surgery and Percutaneous Retrogasserian Glycerol Rhizotomy for Trigeminal Neuralgia in Patients With Multiple Sclerosis. J Neurosurg. 2012;117 Suppl:175-80. PubMed PMID: 23205807.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative study of Gamma Knife surgery and percutaneous retrogasserian glycerol rhizotomy for trigeminal neuralgia in patients with multiple sclerosis. AU - Mathieu,David, AU - Effendi,Khaled, AU - Blanchard,Jocelyn, AU - Séguin,Mario, PY - 2012/12/5/entrez PY - 2012/12/12/pubmed PY - 2013/2/7/medline SP - 175 EP - 80 JF - Journal of neurosurgery JO - J Neurosurg VL - 117 Suppl N2 - OBJECT: Among patients with multiple sclerosis (MS) there is a high incidence of trigeminal neuralgia (TN), and outcomes after treatment seem inferior to those in patients suffering from idiopathic TN. The goal of this study was to evaluate clinical outcomes in patients with MS-related TN after Gamma Knife surgery (GKS) and compare them with those obtained using percutaneous retrogasserian glycerol rhizotomy (PRGR). METHODS: The authors retrospectively reviewed the charts of 45 patients with MS-related TN. The first procedure undertaken was GKS in 27 patients and PRGR in 18 patients. Pain had been present for a median of 60 months (range 12-276 months) in patients who underwent GKS and 48 months (range 12-240 months) in patients who underwent PRGR. The following outcome measures were assessed in both groups of patients: pain relief (using the Barrow Neurological Institute [BNI] Pain Scale), procedure-related morbidity, time to pain relief and recurrence, and subsequent procedures that were performed. RESULTS: The median duration of follow-up was 39 months (range 13-69 months) in the GKS group and 38 months (range 2-75 months) in the PRGR group. Reasonable pain control (BNI Pain Scale Scores I-IIIb) was noted in 22 patients (81.5%) who underwent GKS and in 18 patients (100%) who underwent PRGR. For patients who underwent GKS, the median time to pain relief was 6 months; for those who underwent PRGR, pain relief was immediate. In the GKS group 12 patients required subsequent procedures (3 patients for absence of response and 9 patients for pain recurrence), whereas in the PRGR group 6 patients required subsequent procedures (all for pain recurrence). As of the last follow-up, complete or reasonable pain control was finally achieved in 23 patients (85.2%) in the GKS group and in 16 patients (88.9%) in the PRGR group. The morbidity rate was 22.2% in the GKS group (all due to sensory loss and paresthesia) and 66.7% in the PRGR group (mostly hypalgesia, with 2 patients having corneal reflex loss and 1 patient suffering from meningitis). CONCLUSIONS: Both GKS and PRGR are satisfactory strategies for treating MS-related TN. Gamma Knife surgery has a lower rate of sensory and overall morbidity than PRGR, but requires a delay before pain relief occurs. The authors propose that patients with extreme pain in need of fast relief should undergo PRGR. For other patients, both management strategies can lead to satisfactory pain relief, and the choice should be made based on patient preference and expectations. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/23205807/Comparative_study_of_Gamma_Knife_surgery_and_percutaneous_retrogasserian_glycerol_rhizotomy_for_trigeminal_neuralgia_in_patients_with_multiple_sclerosis_ L2 - https://thejns.org/doi/10.3171/2012.6.GKS12987 DB - PRIME DP - Unbound Medicine ER -