Earlier radiosurgery leads to better pain relief and less medication usage for trigeminal neuralgia patients: an international multicenter study

Abstract

OBJECTIVETrigeminal neuralgia (TN) is a chronic pain condition that is difficult to control with conservative management. Furthermore, disabling medication-related side effects are common. This study examined how stereotactic radiosurgery (SRS) affects pain outcomes and medication dependence based on the latency period between diagnosis and radiosurgery.METHODSThe authors conducted a retrospective analysis of patients with type I TN at 12 Gamma Knife treatment centers. SRS was the primary surgical intervention in all patients. Patient demographics, disease characteristics, treatment plans, medication histories, and outcomes were reviewed.RESULTSOverall, 404 patients were included. The mean patient age at SRS was 70 years, and 60% of the population was female. The most common indication for SRS was pain refractory to medications (81%). The median maximum radiation dose was 80 Gy (range 50–95 Gy), and the mean follow-up duration was 32 months. The mean number of medications between baseline (pre-SRS) and the last follow-up decreased from 1.98 to 0.90 (p < 0.0001), respectively, and this significant reduction was observed across all medication categories. Patients who received SRS within 4 years of their initial diagnosis achieved significantly faster pain relief than those who underwent treatment after 4 years (median 21 vs 30 days, p = 0.041). The 90-day pain relief rate for those who received SRS ≤ 4 years after their diagnosis was 83.8% compared with 73.7% in patients who received SRS > 4 years after their diagnosis. The maximum radiation dose was the strongest predictor of a durable pain response (OR 1.091, p = 0.003). Early intervention (OR 1.785, p = 0.007) and higher maximum radiation dose (OR 1.150, p < 0.0001) were also significant predictors of being pain free (a Barrow Neurological Institute pain intensity score of I–IIIA) at the last follow-up visit. New sensory symptoms of any kind were seen in 98 patients (24.3%) after SRS. Higher maximum radiation dose trended toward predicting new sensory deficits but was nonsignificant (p = 0.075).CONCLUSIONSTN patients managed with SRS within 4 years of diagnosis experienced a shorter interval to pain relief with low risk. SRS also yielded significant decreases in adjunct medication utilization. Radiosurgery should be considered earlier in the course of treatment for TN.

Outcomes using linear accelerator stereotactic radiosurgery for the treatment of trigeminal neuralgia: A single-center, retrospective study

“…In a recent systematic analysis, the mean rate of pain freedom in Type 1 patients with or without medication was comparable among the modalities (85% for LINAC, 87% for GKS, and 79% for CKR, meta-analysis covering studies from 1951 to 2015, [ Table 2 ]). [ 4 , 6 , 11 , 12 , 17 , 18 , 22 , 24 , 26 , 27 ] These findings are comparable with our results of 72% of patients having pain control with or without medications (a BNI score of 1–3) and 71% of Burchiel Type 1 patients improving. We reviewed studies published from 2016 to 2022 that reported the rate of pain treatment in patients with Type 1 TN treated with either GK or LINAC [ Table 2 ] and found roughly 70–80% pain treatment effect (BNI 1–3) for GK and an 80–90% rate of pain control with LINAC (which is slightly better than our report).…”

Letter to the Editor. Pain outcomes for trigeminal neuralgia

“…TO THE EDITOR: We read with great interest the multicenter retrospective study by Mureb et al 1 on radiosurgery for type 1 trigeminal neuralgia (TN) published in the Journal of Neurosurgery in July 2020 (Mureb M, Golub D, Benjamin C, et al Earlier radiosurgery leads to better pain relief and less medication usage for trigeminal neuralgia patients: an international multicenter study. J Neurosurg.…”

Clinical Depression and Anxiety Are Relieved by Microvascular Decompression in Patients with Trigeminal Neuralgia—A Prospective Patient-Reported Outcome Study

“…Furthermore, since the efficacy of medical management typically decreases over time, many patients turn to surgical intervention for more durable pain relief [7]. In addition, the scientific evidence for the drug treatment of TN is weak [19].…”

“…Beyond medical and surgical management, strategies for TN may also include interventional procedures such as percutaneous techniques (e.g., balloon compression, glycerol rhizotomy and radiofrequency thermal lesioning) and non-invasive modalities like stereotactic radiosurgery [2][3][4][5][6]. Each treatment option carries its own risk-benefit profile and potential impact on the patient's quality of life [7][8][9], highlighting the importance of personalized treatment planning.…”