Long-Term Outcome of Gamma Knife Surgery Using a Retrogasserian Petrous Bone Target for Classic Trigeminal Neuralgia

Lee, Jung Kyo; Kim, Deok Ryeong; Huh, Yeon Hee; Kim, Jin‐Kyung; Namgung, Won Chul; Hong, Seok Ho

doi:10.1007/978-3-7091-1376-9_20

Cited by 15 publications

(9 citation statements)

References 31 publications

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“…Results are better in typical neuralgia with single nerve distribution pain. [ 88 ] About 37%[ 97 ] and 95%[ 98 ] of patients become pain free within 48 h, and 10 days of procedure, respectively. Although the long-term results of GKRS are not as satisfactory as MVD,[ 99 100 ] it is an effective alternative with more than 50% long-lasting pain relief.…”

Section: Gamma Knife Radiosurgerymentioning

confidence: 99%

Trigeminal neuralgia

Yadav

Pande

et al. 2017

Asian J Neurosurg

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Trigeminal neuralgia (TN) is a sudden, severe, brief, stabbing, and recurrent pain within one or more branches of the trigeminal nerve. Type 1 as intermittent and Type 2 as constant pain represent distinct clinical, pathological, and prognostic entities. Although multiple mechanism involving peripheral pathologies at root (compression or traction), and dysfunctions of brain stem, basal ganglion, and cortical pain modulatory mechanisms could have role, neurovascular conflict is the most accepted theory. Diagnosis is essentially clinically; magnetic resonance imaging is useful to rule out secondary causes, detect pathological changes in affected root and neurovascular compression (NVC). Carbamazepine is the drug of choice; oxcarbazepine, baclofen, lamotrigine, phenytoin, and topiramate are also useful. Multidrug regimens and multidisciplinary approaches are useful in selected patients. Microvascular decompression is surgical treatment of choice in TN resistant to medical management. Patients with significant medical comorbidities, without NVC and multiple sclerosis are generally recommended to undergo gamma knife radiosurgery, percutaneous balloon compression, glycerol rhizotomy, and radiofrequency thermocoagulation procedures. Partial sensory root sectioning is indicated in negative vessel explorations during surgery and large intraneural vein. Endoscopic technique can be used alone for vascular decompression or as an adjuvant to microscope. It allows better visualization of vascular conflict and entire root from pons to ganglion including ventral aspect. The effectiveness and completeness of decompression can be assessed and new vascular conflicts that may be missed by microscope can be identified. It requires less brain retraction.

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Section: Gamma Knife Radiosurgerymentioning

confidence: 99%

Trigeminal neuralgia

Yadav

Pande

et al. 2017

Asian J Neurosurg

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“…In some studies, root entry zone radiation dose were suggested to be important and root entry zone targets were used (3,15,20,36). In the other studies, retrogasserian targets were also effective and suggested to result in lower complication rate (23,35,44). In one study, moving target location slightly was tended to be related with good outcome (48).…”

Section: Target and Brainstem Radiation Dosesmentioning

confidence: 95%

“…However, the suggested threshold in that study was much higher at 43.9 Gy (34). In our previous study of single GKS for trigeminal neuralgia, distant targets resulted in more facial numbness (23). In other studies, no relationship was reported (6).…”

Section: Conundrums Related To Brainstem Radiation Doses and Trigeminmentioning

confidence: 96%

“…4 and Table 3) and may be related to complications. In our previous study of a retrogasserian target GKS for trigeminal neuralgia, it was possible to perform GKS with a median 7 8 mm distance when the target was selected to be as distant from the brainstem as possible (23). At this distance, the cumulative dosage can be restricted to below 12 Gy, even in repeat GKS patients (Fig.…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 96%

“…In our study, target isocenter locations are relatively constant and retrogasserian targets just above the retrogasserian petrous bone was used (23). Targets were identified usually with MRI fused with CT images in most 25 GKS (89.3 %) except 3 GKS (10.7 %) targeted root-entry zone.…”

Section: Introductionmentioning

confidence: 99%

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