Stereotactic gamma knife surgery for trigeminal neuralgia: detailed analysis of treatment response
Rabih G. Tawk
Rabih G. Tawk
Departments of Neurosurgery, Radiation Oncology, Radiation Physics, and Diagnostic Radiology, Roswell Park Cancer Institute and State University of New York School of Medicine and Biomedical Sciences, Buffalo, New York
Mary Duffy-Fronckowiak
Departments of Neurosurgery, Radiation Oncology, Radiation Physics, and Diagnostic Radiology, Roswell Park Cancer Institute and State University of New York School of Medicine and Biomedical Sciences, Buffalo, New York
Bryan E. Scott
Departments of Neurosurgery, Radiation Oncology, Radiation Physics, and Diagnostic Radiology, Roswell Park Cancer Institute and State University of New York School of Medicine and Biomedical Sciences, Buffalo, New York
Ronald A. Alberico
Departments of Neurosurgery, Radiation Oncology, Radiation Physics, and Diagnostic Radiology, Roswell Park Cancer Institute and State University of New York School of Medicine and Biomedical Sciences, Buffalo, New York
Aidnag Z. Diaz
Departments of Neurosurgery, Radiation Oncology, Radiation Physics, and Diagnostic Radiology, Roswell Park Cancer Institute and State University of New York School of Medicine and Biomedical Sciences, Buffalo, New York
Matthew B. Podgorsak
Departments of Neurosurgery, Radiation Oncology, Radiation Physics, and Diagnostic Radiology, Roswell Park Cancer Institute and State University of New York School of Medicine and Biomedical Sciences, Buffalo, New York
Robert J. Plunkett
Departments of Neurosurgery, Radiation Oncology, Radiation Physics, and Diagnostic Radiology, Roswell Park Cancer Institute and State University of New York School of Medicine and Biomedical Sciences, Buffalo, New York
Robert A. Fenstermaker
Departments of Neurosurgery, Radiation Oncology, Radiation Physics, and Diagnostic Radiology, Roswell Park Cancer Institute and State University of New York School of Medicine and Biomedical Sciences, Buffalo, New York
Object.The purpose of this study was to assess the durability and completeness of pain relief in patients treated using stereotactic gamma knife surgery (GKS) for trigeminal neuralgia (TN).
Methods.38例难治性TN患者胎面ted with stereotactic GKS. All patients received a prescription radiation dose of 35, 40, or 45 Gy to the 50% isodose surface through a 4-mm collimator helmet. The group was assessed regularly based on physician-directed interviews for a median follow up of 24 months (range 6–27 months). Pain relief was classified as excellent (no pain without medication), good (well-controlled pain with continued medication), fair (decreased but residual pain with continued medication), or poor (unimproved or increased pain with the same or increased medication).
Three months after treatment, pain relief was good or excellent in 71% of patients. By 24 months post-GKS, 50% of the original cohort had poor pain relief, 21% continued to have either excellent or good relief, 3% had fair relief, and 26% had not reached the 24-month follow up. Based on their status at the last follow up, 29% of patients had excellent and 16% had good pain relief. Thirty-seven percent experienced facial numbness, which was dose related. In addition, there was a significantly higher rate of complete pain relief in patients who had facial numbness following treatment (p = 0.003).
Conclusions.Stereotactic GKS is an effective treatment in patients with TN; however, the durability of pain relief and the time to treatment response are limiting factors. As with other types of ablative treatment, facial numbness is strongly associated with better treatment response.
Address reprint requests to:Robert A. Fenstermaker, M.D., Department of Neurosurgery, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, New York 14263. email:Robert.Fenstermaker@RoswellPark.org.
AlbericoRA,,FenstermakerRA,&LobelJ:Focal enhancement of cranial nerve V after radiosurgery with the Leksell gamma knife: experience in 15 patients with medically refractory trigeminal neuralgia.AJNR22:1944–1948,2001Alberico RA, Fenstermaker RA, Lobel J: Focal enhancement of cranial nerve V after radiosurgery with the Leksell gamma knife: experience in 15 patients with medically refractory trigeminal neuralgia.AJNR 22:1944–1948, 2001
Alberico
RA
,
Fenstermaker
RA
,
Lobel
J
:
Focal enhancement of cranial nerve V after radiosurgery with the Leksell gamma knife: experience in 15 patients with medically refractory trigeminal neuralgia.AJNR
22
:
1944
–
1948
,
2001
Alberico RA, Fenstermaker RA, Lobel J: Focal enhancement of cranial nerve V after radiosurgery with the Leksell gamma knife: experience in 15 patients with medically refractory trigeminal neuralgia.
AJNR 22:1944–1948, 2001)| false
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
Brisman
R
:
Gamma knife surgery with a dose of 75 to 76.8 Gray for trigeminal neuralgia.J Neurosurg
100
:
848
–
854
,
2004
Brisman R: Gamma knife surgery with a dose of 75 to 76.8 Gray for trigeminal neuralgia.
J Neurosurg 100:848–854, 2004
10.3171/jns.2004.100.5.0848)| false
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
Brisman
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.开云体育app官方网站下载入口
50
:
1261
–
1267
,
2002
Brisman 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)| false
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
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
Burchiel
KJ
,
Slavin
KV
:
On the natural history of trigeminal neuralgia.开云体育app官方网站下载入口
46
:
152
–
155
,
2000
Burchiel KJ, Slavin KV: On the natural history of trigeminal neuralgia.
Neurosurgery 46:152–155, 2000
10.1093/neurosurgery/46.1.152)| false
HardyDG,&RhotonALJr:Microsurgical relationships of the superior cerebellar artery and the trigeminal nerve.J Neurosurg49:669–678,1978Hardy DG, Rhoton AL Jr: Microsurgical relationships of the superior cerebellar artery and the trigeminal nerve.J Neurosurg 49:669–678, 1978
Hardy
DG
,
Rhoton
AL
Jr
:
Microsurgical relationships of the superior cerebellar artery and the trigeminal nerve.J Neurosurg
49
:
669
–
678
,
1978
Hardy DG, Rhoton AL Jr: Microsurgical relationships of the superior cerebellar artery and the trigeminal nerve.
J Neurosurg 49:669–678, 1978
10.3171/jns.1978.49.5.0669)| false
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
Jannetta
PJ
:
Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia.J Neurosurg
26
(Suppl)
:
159
–
162
,
1967
Jannetta PJ: Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia.
J Neurosurg 26 (Suppl):159–162, 1967
10.3171/jns.1967.26.1part2.0159)| false
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
Kondziolka
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
Kondziolka 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
10.3171/jns.1996.84.6.0940)| false
MassagerN,,LorenzoniJ,,DevriendtD,,DesmedtF,,BrotchiJ,&LevivierM:Gamma knife surgery for idiopathic trigeminal neuralgia performed using a far-anterior cisternal target and a high dose of radiation.J Neurosurg100:597–605,2004Massager N, Lorenzoni J, Devriendt D, Desmedt F, Brotchi J, Levivier M: Gamma knife surgery for idiopathic trigeminal neuralgia performed using a far-anterior cisternal target and a high dose of radiation.J Neurosurg 100:597–605, 2004
Massager
N
,
Lorenzoni
J
,
Devriendt
D
,
Desmedt
F
,
Brotchi
J
,
Levivier
M
:
Gamma knife surgery for idiopathic trigeminal neuralgia performed using a far-anterior cisternal target and a high dose of radiation.J Neurosurg
100
:
597
–
605
,
2004
Massager N, Lorenzoni J, Devriendt D, Desmedt F, Brotchi J, Levivier M: Gamma knife surgery for idiopathic trigeminal neuralgia performed using a far-anterior cisternal target and a high dose of radiation.
J Neurosurg 100:597–605, 2004
10.3171/jns.2004.100.4.0597)| false
MatsudaS,,SerizawaT,,SatoM,&OnoJ:Gamma knife radiosurgery for trigeminal neuralgia: the dry-eye complication.J Neurosurg97:525–528,2002Matsuda S, Serizawa T, Sato M, Ono J: Gamma knife radiosurgery for trigeminal neuralgia: the dry-eye complication.J Neurosurg 97:525–528, 2002
Matsuda
S
,
Serizawa
T
,
Sato
M
,
Ono
J
:
Gamma knife radiosurgery for trigeminal neuralgia: the dry-eye complication.J Neurosurg
97
:
525
–
528
,
2002
Matsuda S, Serizawa T, Sato M, Ono J: Gamma knife radiosurgery for trigeminal neuralgia: the dry-eye complication.
J Neurosurg 97:525–528, 2002
10.3171/jns.2002.97.supplement_5.0525)| false
NizinPS:On absorbed dose in narrow 60Co gamma-ray beams and dosimetry of the gamma knife.Med Phys25:2347–2351,1998Nizin PS: On absorbed dose in narrow 60Co gamma-ray beams and dosimetry of the gamma knife.Med Phys 25:2347–2351, 1998
Nizin
PS
:
On absorbed dose in narrow 60Co gamma-ray beams and dosimetry of the gamma knife.Med Phys
25
:
2347
–
2351
,
1998
Nizin PS: On absorbed dose in narrow 60Co gamma-ray beams and dosimetry of the gamma knife.
Med Phys 25:2347–2351, 1998
10.1118/1.598444)| false
PetitJH,,HermanJM,,NagdaS,,DiBiaseSJ,&ChinLS:Radiosurgical treatment of trigeminal neuralgia: evaluating quality of life and treatment outcomes.Int J Radiat Oncol Biol Phys56:1147–1153,2003Petit JH, Herman JM, Nagda S, DiBiase SJ, Chin LS: Radiosurgical treatment of trigeminal neuralgia: evaluating quality of life and treatment outcomes.Int J Radiat Oncol Biol Phys 56:1147–1153, 2003
Petit
JH
,
Herman
JM
,
Nagda
S
,
DiBiase
SJ
,
Chin
LS
:
Radiosurgical treatment of trigeminal neuralgia: evaluating quality of life and treatment outcomes.Int J Radiat Oncol Biol Phys
56
:
1147
–
1153
,
2003
Petit JH, Herman JM, Nagda S, DiBiase SJ, Chin LS: Radiosurgical treatment of trigeminal neuralgia: evaluating quality of life and treatment outcomes.
Int J Radiat Oncol Biol Phys 56:1147–1153, 2003
10.1016/S0360-3016(03)00264-5)| false
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
Regis
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
Regis 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
10.1016/S1042-3680(18)30201-8)| false
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
Rogers
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
Rogers 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
10.1016/S0360-3016(00)00513-7)| false
Taha
JM
,
努力工作
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
Taha 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
10.3171/jns.1995.83.6.0989)| false
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
Wilson
CB
,
Yorke
C
,
Prioleau
G
:
Microsurgical vascular decompression for trigeminal neuralgia and hemifacial spasm.West J Med
132
:
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)| false
YoungRF,,雅克。DS,&MarkR:Gamma Knife radiosurgery for treatment of trigeminal neuralgia: long-term results.开云体育app官方网站下载入口49:533–534,2001(Abstract)Young RF, Jacques DS, Mark R: Gamma Knife radiosurgery for treatment of trigeminal neuralgia: long-term results.Neurosurgery 49:533–534, 2001 (Abstract)
Young
RF
,
雅克。
DS
,
Mark
R
:
Gamma Knife radiosurgery for treatment of trigeminal neuralgia: long-term results.开云体育app官方网站下载入口
49
:
533
–
534
,
2001
(Abstract)
Young RF, Jacques DS, Mark R: Gamma Knife radiosurgery for treatment of trigeminal neuralgia: long-term results.
Neurosurgery 49:533–534, 2001 (Abstract))| false
