Gamma Knife radiosurgery for trigeminal neuralgia: the impact of magnetic resonance imaging–detected vascular impingement of the affected nerve

Sheehan, Jason P.; Ray, Dibyendu K.; Monteith, Stephen J.; Yen, Chun Po; Lesnick, James E.; Kersh, Ronald; Schlesinger, David

doi:10.3171/2009.9.jns09196

Cited by 38 publications

(24 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recently, it has been evidenced that overall pain relief following GKRS was comparable in patients with and without evidence of vascular compression on MRI. In the subgroup analysis of those with MRI evidence of vessel impingement of the affected trigeminal nerve, pain relief correlated with a higher dose to the point of contact between the impinging vessel and the trigeminal nerve 132. Nonetheless, in a recent prospective cohort study comparing GKRS and MVD, the last one was significantly superior to GKRS in maintaining a pain-free status and provided similar early and superior longer-term patient satisfaction rates compared to GKRS 133…”

Section: Advances In Surgical Therapymentioning

confidence: 95%

Advances in diagnosis and treatment of trigeminal neuralgia

Montano¹,

Conforti²,

Bonaventura³

et al. 2015

TCRM

158

View full text Add to dashboard Cite

Various drugs and surgical procedures have been utilized for the treatment of trigeminal neuralgia (TN). Despite numerous available approaches, the results are not completely satisfying. The need for more contemporaneous drugs to control the pain attacks is a common experience. Moreover, a number of patients become drug resistant, needing a surgical procedure to treat the neuralgia. Nonetheless, pain recurrence after one or more surgical operations is also frequently seen. These facts reflect the lack of the precise understanding of the TN pathogenesis. Classically, it has been related to a neurovascular compression at the trigeminal nerve root entry-zone in the prepontine cistern. However, it has been evidenced that in the pain onset and recurrence, various neurophysiological mechanisms other than the neurovascular conflict are involved. Recently, the introduction of new magnetic resonance techniques, such as voxel-based morphometry, diffusion tensor imaging, three-dimensional time-of-flight magnetic resonance angiography, and fluid attenuated inversion recovery sequences, has provided new insight about the TN pathogenesis. Some of these new sequences have also been used to better preoperatively evidence the neurovascular conflict in the surgical planning of microvascular decompression. Moreover, the endoscopy (during microvascular decompression) and the intraoperative computed tomography with integrated neuronavigation (during percutaneous procedures) have been recently introduced in the challenging cases. In the last few years, efforts have been made in order to better define the optimal target when performing the gamma knife radiosurgery. Moreover, some authors have also evidenced that neurostimulation might represent an opportunity in TN refractory to other surgical treatments. The aim of this work was to review the recent literature about the pathogenesis, diagnosis, and medical and surgical treatments, and discuss the significant advances in all these fields.

show abstract

Section: Advances In Surgical Therapymentioning

confidence: 95%

Advances in diagnosis and treatment of trigeminal neuralgia

Montano¹,

Conforti²,

Bonaventura³

et al. 2015

TCRM

158

View full text Add to dashboard Cite

show abstract

“…5,23 Furthermore, TN attributed to microvascular compression at the site of the DREZ is by far the most accepted theory in terms of the mechanism of TN based on the findings of Barker et al 1 The disparity in PR duration in this study may indicate that the location of the DREZ is highly variable, and this variability in DREZ location has been described by De Ridder et al 3 Our group previously published a study regarding the impact of vascular compression on the efficacy of radiosurgery for TN. 22 In that study of 106 patients with TN, GKRS proved more effective when the radiosurgery was delivered closer to the point of vascular impingement on the trigeminal nerve. That finding may recapitulate the more favorable pain relief after radiosurgery when targeting the proximal DREZ.…”

Section: Discussionmentioning

confidence: 99%

Impact of target location on the response of trigeminal neuralgia to stereotactic radiosurgery

Xu¹,

Schlesinger

Moldovan³

et al. 2014

JNS

Self Cite

View full text Add to dashboard Cite

Object The authors evaluate the impact of target location on the rate of pain relief (PR) in patients with intractable trigeminal neuralgia (TN) undergoing stereotactic radiosurgery (SRS). Methods The authors conducted a retrospective review of 99 patients with idiopathic TN who were identified from a prospectively maintained database and were treated with SRS targeting the dorsal root entry zone with a maximum dose of 80 Gy. Targeting of the more proximal portion of a trigeminal nerve with the 50% isodose line overlapping the brainstem was performed in 36 patients (proximal group). In a matched group, 63 patients received SRS targeting the 20% isodose line tangential to the emergence of the brainstem (distal group). The median follow-up time was 33 months (range 6–124 months). Results The actuarial rate of maintenance of Barrow Neurological Institute (BNI) Pain Score I–IIIa was attained in 89% of patients at 1 year, 81% at 2 years, and 69% at 4 years, respectively, after SRS. Kaplan-Meier analysis revealed that durability of PR was only associated with the proximal location of the radiosurgical target (log-rank test, p = 0.018). Radiosurgery-induced facial numbness (BNI Score II or III) developed in 35 patients, which was significantly more frequent in the proximal group (19 patients [53%] compared with 16 [25%] in the distal group [p = 0.015]). Conclusions The radiosurgical target appears to affect the duration of pain relief in patients with idiopathic trigeminal neuralgia with the target closer to the brainstem affording extended pain relief. However, the proximal SRS target was also associated with an increased risk of mild to moderate facial numbness.

show abstract

“…Brisman and Mooij, in a series of 172 patients with trigeminal neuralgia treated with a maximum dose of 75 Gy, demonstrated that treatments in which the brainstem received 20% or more of the maximum dose to a volume of 20 mm 3 provided better pain control than those who had smaller volumes targeted with lower doses [19]. In work from our group, we have observed that a higher dose delivered to the point of contact between an impinging vessel and the affected trigeminal nerve is more likely to induce pain relief in those undergoing radiosurgery for typical trigeminal neuralgia [25]. In cases where higher doses were required, the isocenter was usually placed away from the brainstem, presuming that would decrease the risk of side effects.…”

Section: Target Of Radiosurgery For Trigeminal Neuralgiamentioning

confidence: 77%

Gamma Knife^®radiosurgery for trigeminal neuralgia

Yen

Schlesinger

Sheehan

2011

Expert Review of Medical Devices

Self Cite

View full text Add to dashboard Cite

Trigeminal neuralgia is characterized by a temporary paroxysmal lancinating facial pain in the trigeminal nerve distribution. The prevalence is four to five per 100,000. Local pressure on nerve fibers from vascular loops results in painful afferent discharge from an injured segment of the fifth cranial nerve. Microvascular decompression addresses the underlying pathophysiology of the disease, making this treatment the gold standard for medically refractory trigeminal neuralgia. In patients who cannot tolerate a surgical procedure, those in whom a vascular etiology cannot be identified, or those unwilling to undergo an open surgery, stereotactic radiosurgery is an appropriate alternative. The majority of patients with typical facial pain will achieve relief following radiosurgical treatment. Long-term follow-up for recurrence as well as for radiation-induced complications is required in all patients undergoing stereotactic radiosurgery for trigeminal neuralgia.

show abstract

Gamma Knife radiosurgery for trigeminal neuralgia: the impact of magnetic resonance imaging–detected vascular impingement of the affected nerve

Cited by 38 publications

References 30 publications

Advances in diagnosis and treatment of trigeminal neuralgia

Advances in diagnosis and treatment of trigeminal neuralgia

Impact of target location on the response of trigeminal neuralgia to stereotactic radiosurgery

Gamma Knife^®radiosurgery for trigeminal neuralgia

Contact Info

Product

Resources

About

Gamma Knife radiosurgery for trigeminal neuralgia: the impact of magnetic resonance imaging–detected vascular impingement of the affected nerve

Cited by 38 publications

References 30 publications

Advances in diagnosis and treatment of trigeminal neuralgia

Advances in diagnosis and treatment of trigeminal neuralgia

Impact of target location on the response of trigeminal neuralgia to stereotactic radiosurgery

Gamma Knife®radiosurgery for trigeminal neuralgia

Contact Info

Product

Resources

About

Gamma Knife^®radiosurgery for trigeminal neuralgia