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The results of a third Gamma Knife procedure for recurrent trigeminal neuralgia.
J Neurosurg. 2015 Jan; 122(1):169-79.JN

Abstract

OBJECT

Gamma Knife radiosurgery (GKRS) is the least invasive treatment option for medically refractory, intractable trigeminal neuralgia (TN) and is especially valuable for treating elderly, infirm patients or those on anticoagulation therapy. The authors reviewed pain outcomes and complications in TN patients who required 3 radiosurgical procedures for recurrent or persistent pain.

METHODS

A retrospective review of all patients who underwent 3 GKRS procedures for TN at 4 participating centers of the North American Gamma Knife Consortium from 1995 to 2012 was performed. The Barrow Neurological Institute (BNI) pain score was used to evaluate pain outcomes.

RESULTS

Seventeen patients were identified; 7 were male and 10 were female. The mean age at the time of last GKRS was 79.6 years (range 51.2-95.6 years). The TN was Type I in 16 patients and Type II in 1 patient. No patient suffered from multiple sclerosis. Eight patients (47.1%) reported initial complete pain relief (BNI Score I) following their third GKRS and 8 others (47.1%) experienced at least partial relief (BNI Scores II-IIIb). The average time to initial response was 2.9 months following the third GKRS. Although 3 patients (17.6%) developed new facial sensory dysfunction following primary GKRS and 2 patients (11.8%) experienced new or worsening sensory disturbance following the second GKRS, no patient sustained additional sensory disturbances after the third procedure. At a mean follow-up of 22.9 months following the third GKRS, 6 patients (35.3%) reported continued Score I complete pain relief, while 7 others (41.2%) reported pain improvement (BNI Scores II-IIIb). Four patients (23.5%) suffered recurrent TN following the third procedure at a mean interval of 19.1 months.

CONCLUSIONS

A third GKRS resulted in pain reduction with a low risk of additional complications in most patients with medically refractory and recurrent, intractable TN. In patients unsuitable for other microsurgical or percutaneous strategies, especially those receiving long-term oral anticoagulation or antiplatelet agents, GKRS repeated for a third time was a satisfactory, low risk option.

Authors+Show Affiliations

Department of Neurological Surgery, University of Pittsburgh Medical Center;No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25361482

Citation

Tempel, Zachary J., et al. "The Results of a Third Gamma Knife Procedure for Recurrent Trigeminal Neuralgia." Journal of Neurosurgery, vol. 122, no. 1, 2015, pp. 169-79.
Tempel ZJ, Chivukula S, Monaco EA, et al. The results of a third Gamma Knife procedure for recurrent trigeminal neuralgia. J Neurosurg. 2015;122(1):169-79.
Tempel, Z. J., Chivukula, S., Monaco, E. A., Bowden, G., Kano, H., Niranjan, A., Chang, E. F., Sneed, P. K., Kaufmann, A. M., Sheehan, J., Mathieu, D., & Lunsford, L. D. (2015). The results of a third Gamma Knife procedure for recurrent trigeminal neuralgia. Journal of Neurosurgery, 122(1), 169-79. https://doi.org/10.3171/2014.9.JNS132779
Tempel ZJ, et al. The Results of a Third Gamma Knife Procedure for Recurrent Trigeminal Neuralgia. J Neurosurg. 2015;122(1):169-79. PubMed PMID: 25361482.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The results of a third Gamma Knife procedure for recurrent trigeminal neuralgia. AU - Tempel,Zachary J, AU - Chivukula,Srinivas, AU - Monaco,Edward A,3rd AU - Bowden,Greg, AU - Kano,Hideyuki, AU - Niranjan,Ajay, AU - Chang,Edward F, AU - Sneed,Penny K, AU - Kaufmann,Anthony M, AU - Sheehan,Jason, AU - Mathieu,David, AU - Lunsford,L Dade, PY - 2014/11/1/entrez PY - 2014/11/2/pubmed PY - 2015/3/7/medline KW - BNI = Barrow Neurological Institute KW - GKRS = Gamma Knife radiosurgery KW - Gamma Knife KW - MVD = microvascular decompression KW - NAGKC = North American Gamma Knife Consortium KW - PRGR = percutaneous retrogasserian glycerol rhizotomy KW - TN = trigeminal neuralgia KW - functional neurosurgery KW - microvascular decompression KW - refractory KW - stereotactic radiosurgery KW - trigeminal neuralgia SP - 169 EP - 79 JF - Journal of neurosurgery JO - J Neurosurg VL - 122 IS - 1 N2 - OBJECT: Gamma Knife radiosurgery (GKRS) is the least invasive treatment option for medically refractory, intractable trigeminal neuralgia (TN) and is especially valuable for treating elderly, infirm patients or those on anticoagulation therapy. The authors reviewed pain outcomes and complications in TN patients who required 3 radiosurgical procedures for recurrent or persistent pain. METHODS: A retrospective review of all patients who underwent 3 GKRS procedures for TN at 4 participating centers of the North American Gamma Knife Consortium from 1995 to 2012 was performed. The Barrow Neurological Institute (BNI) pain score was used to evaluate pain outcomes. RESULTS: Seventeen patients were identified; 7 were male and 10 were female. The mean age at the time of last GKRS was 79.6 years (range 51.2-95.6 years). The TN was Type I in 16 patients and Type II in 1 patient. No patient suffered from multiple sclerosis. Eight patients (47.1%) reported initial complete pain relief (BNI Score I) following their third GKRS and 8 others (47.1%) experienced at least partial relief (BNI Scores II-IIIb). The average time to initial response was 2.9 months following the third GKRS. Although 3 patients (17.6%) developed new facial sensory dysfunction following primary GKRS and 2 patients (11.8%) experienced new or worsening sensory disturbance following the second GKRS, no patient sustained additional sensory disturbances after the third procedure. At a mean follow-up of 22.9 months following the third GKRS, 6 patients (35.3%) reported continued Score I complete pain relief, while 7 others (41.2%) reported pain improvement (BNI Scores II-IIIb). Four patients (23.5%) suffered recurrent TN following the third procedure at a mean interval of 19.1 months. CONCLUSIONS: A third GKRS resulted in pain reduction with a low risk of additional complications in most patients with medically refractory and recurrent, intractable TN. In patients unsuitable for other microsurgical or percutaneous strategies, especially those receiving long-term oral anticoagulation or antiplatelet agents, GKRS repeated for a third time was a satisfactory, low risk option. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/25361482/The_results_of_a_third_Gamma_Knife_procedure_for_recurrent_trigeminal_neuralgia_ DB - PRIME DP - Unbound Medicine ER -