Object.Microvascular decompression (MVD) and percutaneous ablation surgery have historically been the treatments of choice for medically refractory trigeminal neuralgia (TN). Gamma knife surgery (GKS) has been used as an alternative, minimally invasive treatment in TN. In the present study, the authors evaluated the long-term results of GKS in the treatment of TN.
Methods.From 1996 to 2003, 151 cases of TN were treated with GKS. In this group, radiosurgery was performed once in 136 patients, twice in 14 patients, and three times in one patient. The types of TN were as follows: 122 patients with typical TN, three with atypical TN, four with multiple sclerosis—associated TN, and seven with TN and a history of a cavernous sinus tumor. In each case, the chosen radiosurgical target was located 2 to 4 mm anterior to the entry of the trigeminal nerve into the pons. The maximal radiation doses ranged from 50 to 90 Gy. The median age of the patients was 68 years (range 22–90 years), and the median time from diagnosis to GKS was 72 months (range 1–276 months). The median follow up was 19 months (range 2–96 months). Clinical outcomes and postradiosurgical magnetic resonance (MR) imaging studies were analyzed. Univariate and multivariate analyses were performed to evaluate factors that correlated with a favorable, pain-free outcome.
The mean time to relief of pain was 24 days (range 1–180 days). Forty-seven, 45, and 34% of patients were pain free without medication at the 1-, 2-, and 3-year follow ups, respectively. Ninety, 77, and 70% of patients experienced some improvement in pain at the 1-, 2-, and 3-year follow ups, respectively. Thirty-three (27%) of 122 patients with initial improvement subsequently experienced pain recurrence a median of 12 months (range 2–34 months) post-GKS. Among those whose symptoms recurred, 14 patients underwent additional GKS, six MVD, four glycerol injection, and one patient a percutaneous radiofrequency rhizotomy. Twelve patients (9%) suffered the onset of new facial numbness post-GKS. Changes on MR images post-GKS were noted in nine patients (7%). On univariate analysis, right-sided neuralgia (p = 0.0002) and a previous neurectomy (p = 0.04) correlated with a pain-free outcome; on multivariate analysis, both right-sided neuralgia (p = 0.032) and patient age (p = 0.05) were statistically significant. New onset of facial numbness following GKS correlated with undergoing more than one GKS (p = 0.002).
Conclusions.At the last follow up, GKS effected pain relief in 44% of patients. Some degree of pain improvement at 3 years post-GKS was noted in 70% of patients with TN. Although less effective than MVD, GKS remains a reasonable treatment option for those unwilling or unable to undergo more invasive surgical approaches and offers a low risk of side effects.
AdrianED:Effects of injury on mammalian nerve fibres.Proc Roy Soc B106:596–618,1930Adrian ED: Effects of injury on mammalian nerve fibres.Proc Roy Soc B 106:596–618, 1930
BarkerFGII,,JannettaPJ,,BissonetteDJ,,LarkinsMV,&JhoHD:The long-term outcome of microvascular decompression for trigeminal neuralgia.N Engl J Med334:1077–1083,1996Barker FG II, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD: The long-term outcome of microvascular decompression for trigeminal neuralgia.N Engl J Med 334:1077–1083, 1996
BrismanR:Gamma knife radiosurgery for primary management for trigeminal neuralgia.J Neurosurg93(Suppl 3):159–161,2000Brisman R: Gamma knife radiosurgery for primary management for trigeminal neuralgia.J Neurosurg 93 (Suppl 3):159–161, 2000
BrismanR:Gamma knife surgery with a dose of 75 to 76.8 Gray for trigeminal neuralgia.J Neurosurg100:848–854,2004Brisman R: Gamma knife surgery with a dose of 75 to 76.8 Gray for trigeminal neuralgia.J Neurosurg 100:848–854, 2004
BrismanR,,KhandjiAG,&MooijRB:Trigeminal nerve-blood vessel relationship as revealed by high-resolution magnetic resonance imaging and its effect on pain relief after gamma knife radiosurgery for trigeminal neuralgia.开云体育app官方网站下载入口50:1261–1267,2002Brisman R, Khandji AG, Mooij RB: Trigeminal nerve-blood vessel relationship as revealed by high-resolution magnetic resonance imaging and its effect on pain relief after gamma knife radiosurgery for trigeminal neuralgia.Neurosurgery 50:1261–1267, 2002
BrismanR,&MooijR:Gamma knife radiosurgery for trigeminal neuralgia: dose-volume histograms of the brainstem and trigeminal nerve.J Neurosurg93(Suppl 3):155–158,2000Brisman R, Mooij R: Gamma knife radiosurgery for trigeminal neuralgia: dose-volume histograms of the brainstem and trigeminal nerve.J Neurosurg 93 (Suppl 3):155–158, 2000
BrownJA,&GoudaJJ:Percutaneous balloon compression of the trigeminal nerve.Neurosurg Clin N Am8:53–62,1997Brown JA, Gouda JJ: Percutaneous balloon compression of the trigeminal nerve.Neurosurg Clin N Am 8:53–62, 1997
BrownJA,,McDanielMD,&WeaverMT:Percutaneous trigeminal nerve compression for treatment of trigeminal neuralgia: results in 50 patients.开云体育app官方网站下载入口32:570–573,1993Brown JA, McDaniel MD, Weaver MT: Percutaneous trigeminal nerve compression for treatment of trigeminal neuralgia: results in 50 patients.Neurosurgery 32:570–573, 1993
BurchielKJ,,ClarkeH,,HaglundM,&LoeserJD:Long-term efficacy of microvascular decompression in trigeminal neuralgia.J Neurosurg69:35–38,1988Burchiel KJ,克拉克H, Haglund M,卫矛JD:长期term efficacy of microvascular decompression in trigeminal neuralgia.J Neurosurg 69:35–38, 1988
BurchielKJ,&SlavinKV:On the natural history of trigeminal neuralgia.开云体育app官方网站下载入口46:152–155,2000Burchiel KJ, Slavin KV: On the natural history of trigeminal neuralgia.Neurosurgery 46:152–155, 2000
GranitR,,LeksellL,&SkoglundCR:Fibre interaction in injured or compressed region of nerve.Brain67:125–140,1944Granit R, Leksell L, Skoglund CR: Fibre interaction in injured or compressed region of nerve.67年大脑:125–140, 1944
HasegawaT,,KondziolkaD,,SpiroR,,FlickingerJC,&LunsfordLD:Repeat radiosurgery for refractory trigeminal neuralgia.开云体育app官方网站下载入口50:494–502,2002Hasegawa T, Kondziolka D, Spiro R, Flickinger JC, Lunsford LD: Repeat radiosurgery for refractory trigeminal neuralgia.Neurosurgery 50:494–502, 2002
HeidenhainR:Studien des Physiologischen Instituts Zu Breslau.Leipzig:Verlag,1861, pp1–66Heidenhain R:Studien des Physiologischen Instituts Zu Breslau.Leipzig: Verlag, 1861, pp 1–66
HelfantMH,,LekselL,&StrangRR:Experiences with intractable pain treated by stereotaxic mesencephalotomy.Acta Chir Scand129:573–580,1965Helfant MH, Leksel L, Strang RR: Experiences with intractable pain treated by stereotaxic mesencephalotomy.Acta Chir Scand 129:573–580, 1965
HermanJM,,PetitJH,,AminP,,KwokY,,DuttaPR,&ChinLS:Repeat gamma knife radiosurgery for refractory or recurrent trigeminal neuralgia: treatment outcomes and quality-of-life assessment.Int J Radiat Oncol Biol Phys59:112–116,2004Herman JM, Petit JH, Amin P, Kwok Y, Dutta PR, Chin LS: Repeat gamma knife radiosurgery for refractory or recurrent trigeminal neuralgia: treatment outcomes and quality-of-life assessment.Int J Radiat Oncol Biol Phys 59:112–116, 2004
JannettaPJ:Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia.J Neurosurg26(Suppl):159–162,1967Jannetta PJ: Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia.J Neurosurg 26 (Suppl):159–162, 1967
KondziolkaD,,FlickingerJC,,LunsfordLD,&HabeckM:Trigeminal neuralgia radiosurgery: the University of Pittsburgh experience.Stereotact Funct Neurosurg66(Suppl 1):343–348,1996Kondziolka D, Flickinger JC, Lunsford LD, Habeck M: Trigeminal neuralgia radiosurgery: the University of Pittsburgh experience.Stereotact Funct Neurosurg 66 (Suppl 1):343–348, 1996
KondziolkaD,,LunsfordLD,&FlickingerJC:Stereotactic radiosurgery for the treatment of trigeminal neuralgia.Clin J Pain18:42–47,2002Kondziolka D, Lunsford LD, Flickinger JC: Stereotactic radiosurgery for the treatment of trigeminal neuralgia.Clin J Pain 18:42–47, 2002
KondziolkaD,,LunsfordLD,,FlickingerJC,,YoungRF,,VermeulenS,&DumaCM,et al:Stereotactic radiosurgery for trigeminal neuralgia: a multiinstitutional study using the gamma unit.J Neurosurg84:940–945,1996Kondziolka D, Lunsford LD, Flickinger JC, Young RF, Vermeulen S, Duma CM, et al: Stereotactic radiosurgery for trigeminal neuralgia: a multiinstitutional study using the gamma unit.J Neurosurg 84:940–945, 1996
KondziolkaD,,PerezB,,FlickingerJC,,HabeckM,&LunsfordLD:Gamma knife radiosurgery for trigeminal neuralgia: results and expectations.Arch Neurol55:1524–29,1998Kondziolka D, Perez B, Flickinger JC, Habeck M, Lunsford LD: Gamma knife radiosurgery for trigeminal neuralgia: results and expectations.Arch Neurol 55:1524–29, 1998
LeksellL:Brain Fragments, inSteinerL,,LindquistC,&ForsterD,et al(eds):Radiosurgery: Baseline and Trends.New York:Raven Press,1992, pp263–292Leksell L: Brain Fragments, in Steiner L, Lindquist C, Forster D, et al (eds):Radiosurgery: Baseline and Trends.New York: Raven Press, 1992, pp 263–292
LeksellL:Stereotaxic radiosurgery in trigeminal neuralgia.Acta Chir Scand137:311–314,1971Leksell L: Stereotaxic radiosurgery in trigeminal neuralgia.Acta Chir Scand 137:311–314, 1971
LovelyTJ,&JannettaPJ:Microvascular decompression for trigeminal neuralgia. Surgical technique and long-term results.Neurosurg Clin N Am8:11–29,1997Lovely TJ, Jannetta PJ: Microvascular decompression for trigeminal neuralgia. Surgical technique and long-term results.Neurosurg Clin N Am 8:11–29, 1997
MaesawaS,,SalameC,,FlickingerJC,,PirrisS,,KondziolkaD,&LunsfordLD:Clinical outcomes after stereotactic radiosurgery for idiopathic trigeminal neuralgia.J Neurosurg94:14–20,2001Maesawa S, Salame C, Flickinger JC, Pirris S, Kondziolka D, Lunsford LD: Clinical outcomes after stereotactic radiosurgery for idiopathic trigeminal neuralgia.J Neurosurg 94:14–20, 2001
OlivecronaH:Die Trigeminusneuralgie und ihre Behandlung.Nervenarzt14:49–57,1941Olivecrona H: Die Trigeminusneuralgie und ihre Behandlung.Nervenarzt 14:49–57, 1941
PollockBE,,FooteRL,,StaffordSL,,LinkMJ,,GormanDA,&SchombergPJ:Results of repeated gamma knife radiosurgery for medically unresponsive trigeminal neuralgia.J Neurosurg93(Suppl 3):162–164,2000Pollock BE, Foote RL, Stafford SL, Link MJ, Gorman DA, Schomberg PJ: Results of repeated gamma knife radiosurgery for medically unresponsive trigeminal neuralgia.J Neurosurg 93 (Suppl 3):162–164, 2000
PollockBE,,PhuongLK,,FooteRL,,StaffordSl,&GormanDA:High-dose trigeminal neuralgia radiosurgery associated with increased risk of trigeminal nerve dysfunction.开云体育app官方网站下载入口49:58–64,2001Pollock BE, Phuong LK, Foote RL, Stafford Sl, Gorman DA: High-dose trigeminal neuralgia radiosurgery associated with increased risk of trigeminal nerve dysfunction.Neurosurgery 49:58–64, 2001
PollockBE,,PhuongLK,,GormanDA,,FooteRL,&StaffordSL:Stereotactic radiosurgery for idiopathic trigeminal neuralgia.J Neurosurg97:347–353,2002Pollock BE, Phuong LK, Gorman DA, Foote RL, Stafford SL: Stereotactic radiosurgery for idiopathic trigeminal neuralgia.J Neurosurg 97:347–353, 2002
RandRW,,雅克。DB,,MelbyeRW,,CopcuttBG,,LevenickMN,&FisherMR:Leksell gamma knife treatment of tic douloureux.Stereotact Funct Neurosurg61(Suppl 1):93–102,1993Rand RW, Jacques DB, Melbye RW, Copcutt BG, Levenick MN, Fisher MR: Leksell gamma knife treatment of tic douloureux.Stereotact Funct Neurosurg 61 (Suppl 1):93–102, 1993
RegisJ,,BartolomeiF,,MetellusP,,ReyM,,GentonP,&DravetC,et al:Radiosurgery for trigeminal neuralgia and epilepsy.Neurosurg Clin N Am10:359–377,1999Regis J, Bartolomei F, Metellus P, Rey M, Genton P, Dravet C, et al: Radiosurgery for trigeminal neuralgia and epilepsy.Neurosurg Clin N Am 10:359–377, 1999
RogersCL,,ShetterAG,,FiedlerJA,,SmithKA,,HanPP,&SpeiserBL:Gamma knife radiosurgery for trigeminal neuralgia: the initial experience of the Barrow Neurological Institute.Int J Radiat Oncol Biol Phys47:1013–1019,2000Rogers CL, Shetter AG, Fiedler JA, Smith KA, Han PP, Speiser BL: Gamma knife radiosurgery for trigeminal neuralgia: the initial experience of the Barrow Neurological Institute.Int J Radiat Oncol Biol Phys 47:1013–1019, 2000
ShetterAG,,RogersCL,,PonceF,,FiedlerJA,,SmithK,&SpeiserBL:Gamma knife radiosurgery for recurrent trigeminal neuralgia.J Neurosurg97(Suppl 5):536–538,2002Shetter AG, Rogers CL, Ponce F, Fiedler JA, Smith K, Speiser BL: Gamma knife radiosurgery for recurrent trigeminal neuralgia.J Neurosurg 97 (Suppl 5):536–538, 2002
SkoglundCR:The response to linearly increasing currents in mammalian motor and sensory nerves.Acta Physiol Scand4(Suppl 12):7–75,1942Skoglund CR: The response to linearly increasing currents in mammalian motor and sensory nerves.学报杂志Scand 4 (12):7–75, 1942
SteinerL,,ForsterD,,LeskellL,,最大经济产量ersonBA,&BoethiusJ:Gammathalamotomy in intractable pain.Acta Neurochir52:173–184,1980Steiner L, Forster D, Leskell L, Meyerson BA, Boethius J: Gammathalamotomy in intractable pain.Acta Neurochir 52:173–184, 1980
TahaJM,,努力工作JMJr,&BuncherCR:A prospective 15-year follow up of 154 consecutive patients with trigeminal neuralgia treated by percutaneous stereotactic radiofrequency thermal rhizotomy.J Neurosurg83:989–993,1995Taha JM, Tew JM Jr, Buncher CR: A prospective 15-year follow up of 154 consecutive patients with trigeminal neuralgia treated by percutaneous stereotactic radiofrequency thermal rhizotomy.J Neurosurg 83:989–993, 1995
WilsonCB,,YorkeC,&PrioleauG:Microsurgical vascular decompression for trigeminal neuralgia and hemifacial spasm.West J Med132:481–487,1980威尔逊CB,约克C, Prioleau G:Microsurgical vascular decompression for trigeminal neuralgia and hemifacial spasm.West J Med 132:481–487, 1980
YoungRF,,VermeulenSS,,GrimmP,&PosewitzA:Gamma knife radiosurgery for treatment of trigeminal neuralgia: idiopathic and tumor related.Neurology48:608–614,1997Young RF, Vermeulen SS, Grimm P, Posewitz A: Gamma knife radiosurgery for treatment of trigeminal neuralgia: idiopathic and tumor related.Neurology 48:608–614, 1997
YoungRF,,VermulenS,&PosewitzA:Gamma knife radiosurgery for the treatment of trigeminal neuralgia.Stereotact Funct Neurosurg70(Suppl 1):192–199,1998Young RF, Vermulen S, Posewitz A: Gamma knife radiosurgery for the treatment of trigeminal neuralgia.Stereotact Funct Neurosurg 70 (Suppl 1):192–199, 1998
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