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Early radiosurgery provides superior pain relief for trigeminal neuralgia patients.
Neurology. 2015 Dec 15; 85(24):2159-65.Neur

Abstract

OBJECTIVE

We evaluated factors associated with better outcomes after stereotactic radiosurgery (SRS) when it was performed as the first surgical procedure for medically refractory trigeminal neuralgia.

METHODS

A total of 121 patients (median age 72 years) with medically refractory pain and no prior surgery underwent Gamma Knife SRS as their initial surgical procedure for trigeminal neuralgia. Using a single 4-mm isocenter, patients received an average maximum dose of 80 Gy, delivered to the trigeminal nerve target defined by intraoperative MRI. The median follow-up was 36 months.

RESULTS

Pain relief (Barrow Neurological Institute [BNI] score I-IIIa) was achieved in 107 (88%) patients at a median time of 1 month. Patients who underwent earlier SRS (within 3 years of pain onset) had a shorter interval until pain relief (1 week, p < 0.001), had a longer interval of pain relief off medication (BNI-I, p < 0.001), and had a longer duration of adequate pain control (BNI-I-IIIa, p < 0.001). Median pain-free intervals for patients who underwent SRS at 1, 2, 3, and more than 3 years after trigeminal neuralgia diagnosis were 68, 37, 36, and 10 months, respectively. Patients who responded to SRS within the first 3 weeks after SRS had a longer duration of complete pain relief compared to those with longer response times (p = 0.001). Fifteen patients (12%) reported new sensory dysfunction after SRS.

CONCLUSION

Early SRS as the initial surgical procedure for management of refractory trigeminal neuralgia was associated with faster, better, and longer pain relief when compared to late SRS.

CLASSIFICATION OF EVIDENCE

This study provides Class IV evidence that in patients with medically refractory trigeminal neuralgia, early stereotactic radiosurgery as the initial procedure provides faster, better, and longer pain relief.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Mousavi SH
From the Departments of Neurological Surgery (S.H.M., A.N., F.J.L., S.S.S., J.L.M., L.D.L.) and Radiation Oncology (J.C.F., L.D.L.), University of Pittsburgh Medical Center; and the University of Pittsburgh School of Medicine (M.J.H.), PA.
Niranjan A
From the Departments of Neurological Surgery (S.H.M., A.N., F.J.L., S.S.S., J.L.M., L.D.L.) and Radiation Oncology (J.C.F., L.D.L.), University of Pittsburgh Medical Center; and the University of Pittsburgh School of Medicine (M.J.H.), PA. niranjana@upmc.edu.
Huang MJ
From the Departments of Neurological Surgery (S.H.M., A.N., F.J.L., S.S.S., J.L.M., L.D.L.) and Radiation Oncology (J.C.F., L.D.L.), University of Pittsburgh Medical Center; and the University of Pittsburgh School of Medicine (M.J.H.), PA.
Laghari FJ
From the Departments of Neurological Surgery (S.H.M., A.N., F.J.L., S.S.S., J.L.M., L.D.L.) and Radiation Oncology (J.C.F., L.D.L.), University of Pittsburgh Medical Center; and the University of Pittsburgh School of Medicine (M.J.H.), PA.
Shin SS
From the Departments of Neurological Surgery (S.H.M., A.N., F.J.L., S.S.S., J.L.M., L.D.L.) and Radiation Oncology (J.C.F., L.D.L.), University of Pittsburgh Medical Center; and the University of Pittsburgh School of Medicine (M.J.H.), PA.
Mindlin JL
From the Departments of Neurological Surgery (S.H.M., A.N., F.J.L., S.S.S., J.L.M., L.D.L.) and Radiation Oncology (J.C.F., L.D.L.), University of Pittsburgh Medical Center; and the University of Pittsburgh School of Medicine (M.J.H.), PA.
Flickinger JC
From the Departments of Neurological Surgery (S.H.M., A.N., F.J.L., S.S.S., J.L.M., L.D.L.) and Radiation Oncology (J.C.F., L.D.L.), University of Pittsburgh Medical Center; and the University of Pittsburgh School of Medicine (M.J.H.), PA.
Lunsford LD
From the Departments of Neurological Surgery (S.H.M., A.N., F.J.L., S.S.S., J.L.M., L.D.L.) and Radiation Oncology (J.C.F., L.D.L.), University of Pittsburgh Medical Center; and the University of Pittsburgh School of Medicine (M.J.H.), PA.

MeSH

AdultAgedAged, 80 and overFemaleFollow-Up StudiesHumansMaleMiddle AgedPain ManagementPain MeasurementRadiosurgeryRetrospective StudiesTime FactorsTreatment OutcomeTrigeminal Neuralgia

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26561286

Citation

Mousavi, Seyed H., et al. "Early Radiosurgery Provides Superior Pain Relief for Trigeminal Neuralgia Patients." Neurology, vol. 85, no. 24, 2015, pp. 2159-65.
Mousavi SH, Niranjan A, Huang MJ, et al. Early radiosurgery provides superior pain relief for trigeminal neuralgia patients. Neurology. 2015;85(24):2159-65.
Mousavi, S. H., Niranjan, A., Huang, M. J., Laghari, F. J., Shin, S. S., Mindlin, J. L., Flickinger, J. C., & Lunsford, L. D. (2015). Early radiosurgery provides superior pain relief for trigeminal neuralgia patients. Neurology, 85(24), 2159-65. https://doi.org/10.1212/WNL.0000000000002216
Mousavi SH, et al. Early Radiosurgery Provides Superior Pain Relief for Trigeminal Neuralgia Patients. Neurology. 2015 Dec 15;85(24):2159-65. PubMed PMID: 26561286.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early radiosurgery provides superior pain relief for trigeminal neuralgia patients. AU - Mousavi,Seyed H, AU - Niranjan,Ajay, AU - Huang,Marshall J, AU - Laghari,Fahad J, AU - Shin,Samuel S, AU - Mindlin,Josh L, AU - Flickinger,John C, AU - Lunsford,L Dade, Y1 - 2015/11/11/ PY - 2015/04/23/received PY - 2015/08/21/accepted PY - 2015/11/13/entrez PY - 2015/11/13/pubmed PY - 2016/4/12/medline SP - 2159 EP - 65 JF - Neurology JO - Neurology VL - 85 IS - 24 N2 - OBJECTIVE: We evaluated factors associated with better outcomes after stereotactic radiosurgery (SRS) when it was performed as the first surgical procedure for medically refractory trigeminal neuralgia. METHODS: A total of 121 patients (median age 72 years) with medically refractory pain and no prior surgery underwent Gamma Knife SRS as their initial surgical procedure for trigeminal neuralgia. Using a single 4-mm isocenter, patients received an average maximum dose of 80 Gy, delivered to the trigeminal nerve target defined by intraoperative MRI. The median follow-up was 36 months. RESULTS: Pain relief (Barrow Neurological Institute [BNI] score I-IIIa) was achieved in 107 (88%) patients at a median time of 1 month. Patients who underwent earlier SRS (within 3 years of pain onset) had a shorter interval until pain relief (1 week, p < 0.001), had a longer interval of pain relief off medication (BNI-I, p < 0.001), and had a longer duration of adequate pain control (BNI-I-IIIa, p < 0.001). Median pain-free intervals for patients who underwent SRS at 1, 2, 3, and more than 3 years after trigeminal neuralgia diagnosis were 68, 37, 36, and 10 months, respectively. Patients who responded to SRS within the first 3 weeks after SRS had a longer duration of complete pain relief compared to those with longer response times (p = 0.001). Fifteen patients (12%) reported new sensory dysfunction after SRS. CONCLUSION: Early SRS as the initial surgical procedure for management of refractory trigeminal neuralgia was associated with faster, better, and longer pain relief when compared to late SRS. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that in patients with medically refractory trigeminal neuralgia, early stereotactic radiosurgery as the initial procedure provides faster, better, and longer pain relief. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/26561286/Early_radiosurgery_provides_superior_pain_relief_for_trigeminal_neuralgia_patients_ DB - PRIME DP - Unbound Medicine ER -