Higher dose rate Gamma Knife radiosurgery may provide earlier and longer-lasting pain relief for patients with trigeminal neuralgia

Lee, John Y.K.; Sandhu, Sukhmeet; Miller, Dorothea; Solberg, Timothy D.; Dorsey, Jay F.; Alonso‐Basanta, Michelle

doi:10.3171/2014.12.jns142013

Cited by 43 publications

(32 citation statements)

References 22 publications

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“…This suggests an urgent need to evaluate alternative treatment pathways (such as newer medications, psychological support, earlier surgical interventions and access to newer surgical innovations such stereotactic radiosurgery, neuromodulation). For example, Lee et al 14 have suggested that surgical management can significantly improve quality of life in patients with TN when assessed using the Brief Pain Inventory -Facial. The data presented in the current manuscript provides a starting point for evaluations of the true health burden and cost of TN.…”

Section: Discussionmentioning

confidence: 99%

“…The McGill pain questionnaire was fully completed by 193 of the 225 patients (85.8%). The words were analysed by sensory type (1-10), affective type (11)(12)(13)(14)(15), evaluative type (16) and miscellaneous type (17)(18)(19)(20). The sensory words most commonly used by patients across all Groups were 'shooting' (84.5%), followed by 'sharp' (72.5%) and 'stabbing' (55.4%).…”

Section: [Table 4 Around Here]mentioning

confidence: 99%

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Evaluating the impact of trigeminal neuralgia

Zakrzewska

Mon-Williams

et al. 2017

Pain

171

128

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Patients with idiopathic trigeminal neuralgia (TN) were categorised into 3 subtypes (n = 225). Group 1 (n = 155, 68.9%) had TN without concomitant pain, group 2 (n = 32, 14.2%) had TN with intermittent concomitant pain, and group 3 (n = 39, 16.9%) had TN with autonomic symptoms. We tested 2 hypotheses: (1) that different pain profiles would be associated with the different groups; (2) that the severe pain associated with TN would impact negatively on activities of daily living and thereby result in disability as defined by the World Health Organisation. A different pain profile was found across the groups. We obtained unequivocal evidence that TN causes disability with up to 45% of patients being absent from usual daily activities 15 days or more in the past 6 months. On the Hospital Anxiety and Depression Scale, 35.7% patients had mild-to-severe depression and over 50% were anxious. The Pain Catastrophizing Scale showed that 78% of patients had considerable negative thoughts with scores >20 and a mean score of 36.4. Prior to referral, only 54% had been prescribed carbamazepine while opioids had been prescribed in 14.6% of the patients. Prior to referral, over 80% had already been to 1 specialist centre which had not provided appropriate management. Patients with TN report varied characteristics but all result in some degree of psychosocial disability especially before adequate therapy is attained.

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Section: Discussionmentioning

confidence: 99%

Section: [Table 4 Around Here]mentioning

confidence: 99%

Evaluating the impact of trigeminal neuralgia

Zakrzewska

Mon-Williams

et al. 2017

Pain

171

128

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“…Hypoesthesia is the most common complication of the procedure, occurring in 6-42% of patients 19,29,30,31,32,33,34,35 , with the location isocenter along the trigeminal nerve associated with the development of this side effect 8 . Overall, our series showed 63% of hypoesthesia on follow-up, but most patients (8/12) already had hypoesthesia before radiosurgery, due to previous procedures.…”

Section: Discussionmentioning

confidence: 99%

Gamma knife radiosurgery for trigeminal neuralgia: first case series from Latin America

Constanzo

Silva

Almeida

et al. 2019

Arq. Neuro-Psiquiatr.

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Gamma Knife® radiosurgery (GKRS) for trigeminal neuralgia is an effective treatment with at least a 50% reduction of pain in 75-95% of patients. Objective: To present the first series of patients treated for trigeminal neuralgia using GKRS in Latin America. Methods: Retrospective analysis. Analysis consisted of time to improvement of symptoms, best Barrow Neurological Institute scale (BNI) score after procedure, time without pain, time to recurrence and post-procedural hypoesthesia. Results: Nineteen cases of classical trigeminal neuralgia were analyzed and three cases of symptomatic trigeminal neuralgia were described. Mean time from symptom onset to radiosurgery was 99.6 months, and 78.9% of patients had undergone invasive procedures before treatment. Patients were followed for a mean of 21.7 months. BNI I was achieved in 36.8%, IIIa in 21.1%, IIIb in 21.1%, IV in 5.3% and V in 15.7%. New hypoesthesia developed in 12.1% patients, which was associated with achieving BNI I after the procedure (p < 0.05). Time from diagnosis to GKRS was higher in patients who failed to achieve BNI I (143 vs. 76 months). The distance from the root entry zone in patients who achieved BNI I was greater than patients who did not (1.94 vs. 1.14 mm). Mean distance from the root entry zone in patients with new hypoesthesia was 2.85 mm vs. 1.06 mm (p = 0.06). Conclusion: Clinical response to GKRS is related to the time between diagnosis and procedure, thus its indication should be considered early in the management of these patients.

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“…The minimum clinically important difference in pain outcomes for TN patients undergoing surgical intervention has also been defined for the PFPS. 39 Researchers in another study used the PFPS to detect subtle differences in outcomes depending on the dose rate in Gamma Knife radiosurgery for TN 25 and for which previous outcome tools such as the BNI scale may not have been sensitive enough. 2 The PFPS has recently been endorsed by Zakrzewska and colleagues as the "essential outcome measure" for the systematic study of pain in patients with TN.…”

Section: Outcome Tools In Tn Assessmentmentioning

confidence: 99%

Endoscopic versus microscopic microvascular decompression for trigeminal neuralgia: equivalent pain outcomes with possibly decreased postoperative headache after endoscopic surgery

Lee

Pierce

Sandhu

et al. 2017

Journal of Neurosurgery

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OBJECTIVE Endoscopic surgery has revolutionized surgery of the ventral skull base but has not yet been widely adopted for use in the cerebellopontine angle. Given the relatively normal anatomy of the cerebellopontine angle in patients with trigeminal neuralgia (TN), the authors hypothesized that a fully endoscopic microvascular decompression (E-MVD) might provide pain outcomes equivalent to those of microscopic MVD (M-MVD) but with fewer complications. METHODS The authors conducted a single-institution, single-surgeon retrospective study with patients treated in the period of 2006-2013. Before surgery, all patients completed a questionnaire that included a validated multidimensional pain-outcome tool, the Penn Facial Pain Scale (PFPS, formerly known as Brief Pain Inventory-Facial), an 11-point scale that measures pain intensity, interference with general activities of daily living (ADLs), and facial-specific ADLs. Using a standardized script, independent research assistants conducted follow-up telephone interviews. RESULTS In total, 167 patients were available for follow-ups (66.5% female; 93 patients underwent M-MVD and 74 underwent E-MVD). Preoperative characteristics (i.e., TN classification, PFPS components, and medication use) were similar for the 2 surgical groups except for 2 variables. Patients in the M-MVD group had slightly higher incidence of V3 pain, and the 2 groups differed in the date of surgery and hence in the length of follow-up (2.4 years for the M-MVD group and 1.3 years for the E-MVD group, p < 0.05). There was a trend toward not finding neurovascular conflict at the time of surgery more frequently in the M-MVD than in the E-MVD group (11% vs 7%, p = 0.052). Internal neurolysis was more often performed in the E-MVD group (26% vs 7%, p = 0.001). The 2 groups did not significantly differ in the length of the MVD procedure (approximately 2 hours). Self-reported headaches at 1 month postoperatively were present in 21% of the patients in the M-MVD group versus 7% in the E-MVD group (p = 0.01). Pain outcomes at the most recent followup were equivalent, with patients reporting a 5- to 6-point (70%-80%) improvement in pain intensity, a 5-point (85%) improvement in pain interference with ADLs, and a 6-point (85%) improvement in interference with facial-specific ADLs. Actuarial freedom from pain recurrence was equivalent in the 2 groups, with 80% pain control at 3 years. CONCLUSIONS Both the fully endoscopic MVD and the conventional M-MVD appear to provide patients with equivalent pain outcomes. Complication rates were also similar between the groups, with the exception of the rate of headaches, which was significantly lower in the E-MVD group 1 month postoperatively.

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Higher dose rate Gamma Knife radiosurgery may provide earlier and longer-lasting pain relief for patients with trigeminal neuralgia

Cited by 43 publications

References 22 publications

Evaluating the impact of trigeminal neuralgia

Evaluating the impact of trigeminal neuralgia

Gamma knife radiosurgery for trigeminal neuralgia: first case series from Latin America

Endoscopic versus microscopic microvascular decompression for trigeminal neuralgia: equivalent pain outcomes with possibly decreased postoperative headache after endoscopic surgery

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