Gamma Knife^®radiosurgery for trigeminal neuralgia

Abstract

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.

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

“…The technique of GKRS for patients with TN has been previously described. 21,25 In brief, the Leksell G frame was applied in the operating room under local anesthesia with propofol sedation. Imaging for localization of the trigeminal nerve was performed using a 1.5-T MRI scanner (Avanto model, Siemens Medical Solutions).…”

Trigeminal neuralgia treatment outcomes following Gamma Knife radiosurgery with a minimum 3-year follow-up

“…Both of these studies, however, have been based on shorter follow-up period after radiosurgery. A correlation between history of prior ablative surgery and pain outcomes has long been established for TN pain recurrence after radiosurgery [1]. Given the low number of events in our series with only four patients having had undergone previous ablative procedures, that correlation could not be tested in our current study.…”

“…Trigeminal neuralgia (TN), also known as tic doloreaux, is a debilitating pain condition characterized by agonizing, paroxysmal, and lancinating pain [1]. First-line treatment includes anticonvulsant and antidepressant, but this often fails to provide pain relief and is associated with various side effects, leading patients to seek other treatments options [1].…”

“…First-line treatment includes anticonvulsant and antidepressant, but this often fails to provide pain relief and is associated with various side effects, leading patients to seek other treatments options [1]. Second-line treatment modalities are given to patients whose symptoms are intractable or who cannot tolerate medication.…”

Comparative analysis between 5 mm and 7.5 mm collimators in CyberKnife radiosurgery for trigeminal neuralgia

“…Gamma Knife is one such radiosurgical unit, which is being used traditionally to treat TN. [678] Gamma Knife radiosurgery is an invasive frame based procedure. However, due to technical advancements in precise targeting, linear accelerator based radiosurgery, and robotic radiosurgery are employed to treat the Trigeminal nerve target as a noninvasive frameless procedure.…”