Recurrent trigeminal neuralgia: long term outcome of repeat gamma knife radiosurgery

Gellner, Verena; Kurschel, Senta; Kreil, Wolfgang; Holl, Etienne; Ofner-Kopeinig, Petra; Unger, F.

doi:10.1136/jnnp.2007.142794

Cited by 46 publications

(44 citation statements)

References 23 publications

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“…More than 60% of patients undergoing repeat GKRS experience at least 50% improvement in pain. 1,9,13,16,18,19,24,34,36,45 Yet 25% of patients experienced recurrent pain (BNI Score IV or V) at a median of 17 months following a repeat GKRS. 26,34 We hypothesized that there exists a subset of patients who may benefit from a third radiosurgical procedure, predicted by their prior favorable response to GKRS.…”

Section: Discussionmentioning

confidence: 99%

“…15,27,46 Such patients have been found to benefit from repeat GKRS, with success rates of between 62% and 95% at a median 32-month follow-up. 1,9,13,16,18,19,24,34,36,45 In this report, we describe our experience in a small cohort of patients who ultimately underwent 3 GKRS procedures because of the recurrence of medically intractable pain. We analyze the outcomes in such patients, including the extent and duration of pain relief.…”

mentioning

confidence: 99%

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The results of a third Gamma Knife procedure for recurrent trigeminal neuralgia

Tempel

Chivukula

Monaco

et al. 2015

JNS

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OBJECT Gamma Knife radiosurgery (GKRS) is the least invasive treatment option for medically refractory, intractable trigeminal neuralgia (TN) and is especially valuable for treating elderly, infirm patients or those on anticoagulation therapy. The authors reviewed pain outcomes and complications in TN patients who required 3 radiosurgical procedures for recurrent or persistent pain. METHODS A retrospective review of all patients who underwent 3 GKRS procedures for TN at 4 participating centers of the North American Gamma Knife Consortium from 1995 to 2012 was performed. The Barrow Neurological Institute (BNI) pain score was used to evaluate pain outcomes. RESULTS Seventeen patients were identified; 7 were male and 10 were female. The mean age at the time of last GKRS was 79.6 years (range 51.2–95.6 years). The TN was Type I in 16 patients and Type II in 1 patient. No patient suffered from multiple sclerosis. Eight patients (47.1%) reported initial complete pain relief (BNI Score I) following their third GKRS and 8 others (47.1%) experienced at least partial relief (BNI Scores II–IIIb). The average time to initial response was 2.9 months following the third GKRS. Although 3 patients (17.6%) developed new facial sensory dysfunction following primary GKRS and 2 patients (11.8%) experienced new or worsening sensory disturbance following the second GKRS, no patient sustained additional sensory disturbances after the third procedure. At a mean follow-up of 22.9 months following the third GKRS, 6 patients (35.3%) reported continued Score I complete pain relief, while 7 others (41.2%) reported pain improvement (BNI Scores II–IIIb). Four patients (23.5%) suffered recurrent TN following the third procedure at a mean interval of 19.1 months. CONCLUSIONS A third GKRS resulted in pain reduction with a low risk of additional complications in most patients with medically refractory and recurrent, intractable TN. In patients unsuitable for other microsurgical or percutaneous strategies, especially those receiving long-term oral anticoagulation or antiplatelet agents, GKRS repeated for a third time was a satisfactory, low risk option.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

The results of a third Gamma Knife procedure for recurrent trigeminal neuralgia

Tempel

Chivukula

Monaco

et al. 2015

JNS

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“…To our knowledge, only 2 other papers have described patients with a third course of GKRS for TN. 10,14 Gellner et al reports on 2 patients who had each undergone a third and fourth GKRS treatment with single isocenters; however, very little information is reported about these patients. 10 One patient underwent a third GKRS 2 years after a second radiosurgical procedure and a fourth GKRS 12 months later.…”

Section: 15mentioning

confidence: 99%

“…10,14 Gellner et al reports on 2 patients who had each undergone a third and fourth GKRS treatment with single isocenters; however, very little information is reported about these patients. 10 One patient underwent a third GKRS 2 years after a second radiosurgical procedure and a fourth GKRS 12 months later. The other patient also underwent a third GKRS 2 years after a second and later underwent thermal coagulation and a subsequent fourth GKRS in a 5-year period.…”

Section: 15mentioning

confidence: 99%

“…Overall, the success of repeat GKRS with regard to pain relief is estimated to be around 60%-70% in numerous studies. 10,25 However, patients undergoing GKRS have better response rates if they have not undergone a prior surgical intervention. 23 Studies on the GKRS doses used for TN have reported that doses ≥ 70 Gy provide better pain control than doses < 70 Gy.…”

Section: 15mentioning

confidence: 99%

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A successful case of multiple stereotactic radiosurgeries for ipsilateral recurrent trigeminal neuralgia

Daugherty¹,

Bhavsar

Hahn³

et al. 2015

JNS

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Trigeminal neuralgia is a common pain syndrome primarily managed medically, although many patients require surgical or radiotherapeutic intervention. Stereotactic radiosurgery has become a preferred method of treatment given its high efficacy rates and relatively favorable toxicity profile. However, many patients have refractory pain even after repeat courses of stereotactic radiosurgery. Historically, 2 courses have been the limit in such patients. The authors present a case of multiply recurrent trigeminal neuralgia treated with a third course of radiosurgery in which the patient had successful pain control and no additional toxicity. Meticulous attention to the therapeutic technique allows the continued application of stereotactic radiosurgery in patients.

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What Every Neurosurgeon Should Know About Stereotactic Radiosurgery

Black¹,

Tariq²

2009

Textbook of Stereotactic and Functional Neurosurgery

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Recurrent trigeminal neuralgia: long term outcome of repeat gamma knife radiosurgery

Cited by 46 publications

References 23 publications

The results of a third Gamma Knife procedure for recurrent trigeminal neuralgia

The results of a third Gamma Knife procedure for recurrent trigeminal neuralgia

A successful case of multiple stereotactic radiosurgeries for ipsilateral recurrent trigeminal neuralgia

What Every Neurosurgeon Should Know About Stereotactic Radiosurgery

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