Clinical outcomes of 114 patients who underwent Gamma-knife radiosurgery for medically refractory idiopathic trigeminal neuralgia
Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu 610041, Sichuan Province, China.Journal of Clinical Neuroscience (Impact Factor: 1.38). 12/2011; 19(1):71-4. DOI: 10.1016/j.jocn.2011.03.020
The optimal radiation dose and target of Gamma-knife radiosurgery (GKRS) for medically refractory idiopathic trigeminal neuralgia (TN) are contentious. We investigated the effects and trigeminal nerve deficits of GKRS using two isocenters to treat a great length of the trigeminal nerve. Between January 2005 and March 2010, 129 patients with idiopathic TN underwent GKRS at the West China Hospital of Sichuan University. A maximum central dose of 80-90 Gy was delivered to the trigeminal nerve root with two isocenters via a 4mm collimator helmet. One hundred and fourteen patients were followed-up periodically by telephone interview to determine the effects, trigeminal nerve deficits and time to the onset of pain relief. The mean follow-up duration was 29.6 months. One hundred and nine patients had complete or partial pain relief and the treatment failed in five patients. Nine patients experienced a recurrence after a mean time of 12.7 months, following an initial interval of pain relief. There were no significant differences between patients with different grades of pain relief with respect to central doses. The mean time to the onset of pain relief was 3.6 weeks. The time to the onset of complete pain relief was significantly shorter than that for partial pain relief. Forty-nine patients reported mild-to-moderate facial numbness and one patient experienced paroxysmal temporalis muscle spasms two weeks after the treatment. GKRS treatment for medically refractory idiopathic TN with two isocenters resulted in an initial pain improvement in 95.6% of patients. The early response to the treatment might suggest a good outcome but, given the high incidence of nerve deficits, GKRS for TN with two isocenters is not recommended as a routine treatment protocol.
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ABSTRACT: The diagnostic and therapeutic problems that arise due to cranial-facial pain are so numerous and varied that the systematization and simplification of their understanding is quite challenging. Yet, this complexity is not at all surprising, due to the extraordinary richness of the sensitive innervations of the face. An extremely dense vascular component must therefore be added to the face. The result of this procedure could very probably become the base of ‘vasomotor disorders’ resulting in the origin of particularly rebel pain. These anatomic-physiological particularities are still very complicated due to the fact that the majority of the facial regions are bordering regions, each belonging to very different domains of expertise. It is in this way that the dentist, stomatologist, neurologist, ophthalmologist and of course the generalist are directly concerned with the vast problem related to cranial-facial pain. Finally, we must remember that the face is an essential element in communicating with other human beings, therefore justifying the frequency and level of importance of a psychological reverberation. This result may in turn modify and often enrich the clinical semiology of facial pain.Revue du Rhumatisme Monographies 02/2013; 80(1):7–14. DOI:10.1016/j.monrhu.2012.12.002
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ABSTRACT: Aim: To analyze the effect of different radiation variables on the outcomes of treatment for trigeminal neuralgia (TN). Materials and methods: Seventy-three patients with refractory TN were treated with a maximum dose of 75-90 Gy using either one (n = 41) or two (n = 32) isocenters and were intensively followed up. The integrated dose delivered to the trigeminal nerve root within the prepontine cistern and the nerve root volume was calculated using the Gamma-Plan system. Relationships between the clinical outcomes and radiation variables were statistically analyzed using a combination of Fisher's exact test and multivariate analyses. Results: At their last follow up, 21 patients (28.8%), 22 patients (30.1%), 19 patients (26%), 6 patients (8.2%), and 5 patients (6.8%) had Grade I-V pain outcomes, respectively, and the average mean dose delivered to the trigeminal nerve root, average integrated dose (mJ) and nerve root volume in prepontine cistern were 45.29 Gy, 4,26 mJ, and 98.47 mm 3 , respectively. The pain relief rate was not significantly improved by a higher amount of integrated dose received by the trigeminal nerve root in prepontine cistern, however, incidence of trigeminal nerve toxicity was increased (P = 0.005). Conclusions: Our limited results suggested that a higher integrated dose might increase the incidence of trigeminal nerve toxicity with no significant benefits in pain relief when the maximal doses were within 75-90 Gy. The protocol for increasing radiation variables such as longer nerve exposure length and higher maximal dose is not recommended as a routine approach and more randomized studies with large number of cases would be required to verify the best treatment strategy of gamma knife radiosurgery for TN.Neurology India 07/2014; 62(4):400-405. DOI:10.4103/0028-3886.141272 · 1.23 Impact Factor
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ABSTRACT: Introduction: Gamma Knife Surgery (GNS) is one of the many techniques used to treat the idiopathic form of trigeminal neuralgia (TN). The aim of this review is to analyse the effectiveness of treatment with GNS in patients affected by recurrent TN. Development: a literature search conducted using MEDLINE, CINAHL, and Scopus in January of 2013 yielded 125 results. After applying the inclusion and exclusion criteria, we selected16 articles evaluating the effectiveness of GNS for reducing symptoms in patients with recurrent TN. Assessment criteria were degree of pain, time to pain relief, pain maintenance, and disease recurrence after the procedure. Conclusions: GNS is considered a non-invasive, safe, and effective treatment for patients with idiopathic TN refractory to medication and surgery. It is currently considered the most advanced means of treating this disease.Neurologia (Barcelona, Spain) 08/2014; DOI:10.1016/j.nrl.2014.02.006 · 1.38 Impact Factor
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