Repeat Gamma-Knife Radiosurgery for Refractory or Recurrent Trigeminal Neuralgia with Consideration About the Optimal Second Dose

Park, Seong-Cheol; Kwon, Do Hoon; Lee, Do Hee; Lee, Jung Kyo

doi:10.1016/j.wneu.2015.08.056

Cited by 17 publications

(16 citation statements)

References 44 publications

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“…After careful evaluation, a total of 22 articles were selected for data retrieval and final analysis. 3,[5][6][7][8][11][12][13][14][15][16][18][19][20][21][22][23]25,26,[28][29][30] Our search failed to identify any study that had directly compared the outcome between repeat GKRS and MVD in patients with prior GKRS failure. Therefore, for purposes of analysis, we grouped the studies into two groups: the first group included studies describing outcome after repeat GKRS (n = 17) and the second group included studies describing outcome after MVD (n = 5).…”

Section: Systematic Review and Meta-analysismentioning

confidence: 99%

“…11 In contrast, a recent meta-analysis has shown poor pain control with a low cumulative dose (< 140-150 Gy). 19 Because individual variation in radiation sensitivity might have a role in the final outcome, a superselective strategy to identify suitable patients for repeat treatment has been recently put forth. In this regard, Tuleasca et al reviewed 20 studies with 626 patients with recurrent TN who received repeat radiosurgery.…”

Section: Role Of Repeat Gkrs In Tnmentioning

confidence: 99%

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Repeat Gamma Knife radiosurgery versus microvascular decompression following failure of GKRS in trigeminal neuralgia: a systematic review and meta-analysis

Patra¹,

Savardekar²,

Dossani³

et al. 2019

Journal of Neurosurgery

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OBJECTIVEGamma Knife radiosurgery (GKRS) has emerged as a promising treatment modality for patients with classical trigeminal neuralgia (TN); however, considering that almost half of the patients experience post-GKRS failure or lesion recurrence, a repeat treatment is typically necessary. The existing literature does not offer clear evidence to establish which treatment modality, repeat GKRS or microvascular decompression (MVD), is superior. The present study aimed to compare the overall outcome of patients who have undergone either repeat GKRS or MVD after failure of their primary GKRS; the authors do so by conducting a systematic review and meta-analysis of the literature and analysis of data from their own institution.METHODSThe authors conducted a systematic review and meta-analysis of the PubMed, Cochrane Library, Web of Science, and CINAHL databases to identify studies describing patients who underwent either repeat GKRS or MVD after initial failed GKRS for TN. The primary outcomes were complete pain relief (CPR) and adequate pain relief (APR) at 1 year. The secondary outcomes were rate of postoperative facial numbness and the retreatment rate. The pooled data were analyzed with R software. Bias and heterogeneity were assessed using funnel plots and I2 tests, respectively. A retrospective analysis of a series of patients treated by the authors who underwent repeat GKRS or MVD after post-GKRS failure or relapse is presented.RESULTSA total of 22 studies met the selection criteria and were included for final data retrieval and meta-analysis. The search did not identify any study that had directly compared outcomes between patients who had undergone repeat GKRS versus those who had undergone MVD. Therefore, the authors’ final analysis included two groups: studies describing outcome after repeat GKRS (n = 17) and studies describing outcome after MVD (n = 5). The authors’ institutional study was the only study with direct comparison of the two cohorts. The pooled estimates of primary outcomes were APR in 83% of patients who underwent repeat GKRS and 88% of those who underwent MVD (p = 0.49), and CPR in 46% of patients who underwent repeat GKRS and 72% of those who underwent MVD (p = 0.02). The pooled estimates of secondary outcomes were facial numbness in 32% of patients who underwent repeat GKRS and 22% of those who underwent MVD (p = 0.11); the retreatment rate was 19% in patients who underwent repeat GKRS and 13% in those who underwent MVD (p = 0.74). The authors’ institutional study included 42 patients (repeat GKRS in 15 and MVD in 27), and the outcomes 1 year after retreatment were APR in 80% of those who underwent repeat GKRS and 81% in those who underwent MVD (p = 1.0); CPR was achieved in 47% of those who underwent repeat GKRS and 44% in those who underwent MVD (p = 1.0). There was no difference in the rate of postoperative facial numbness or retreatment.CONCLUSIONSThe current meta-analysis failed to identify any superiority of one treatment over the other with comparable outcomes in terms of APR, postoperative facial numbness, and retreatment rates. However, MVD was shown to provide a better chance of CPR compared with repeat GKRS.

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Section: Systematic Review and Meta-analysismentioning

confidence: 99%

Section: Role Of Repeat Gkrs In Tnmentioning

confidence: 99%

Repeat Gamma Knife radiosurgery versus microvascular decompression following failure of GKRS in trigeminal neuralgia: a systematic review and meta-analysis

Patra¹,

Savardekar²,

Dossani³

et al. 2019

Journal of Neurosurgery

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“…However, the major side effect of trigeminal nerve deficit is linked with a cumulative brainstem edge dose of >12 Gy ( P = .077). [ 40 ] To date, there is no established cut-off for dose, and there was a tendency to decrease the dose at second GKRS in most studies to avoid dysfunction. [ 36 ] Although both RF-TR and GKRS provide convincing pain relief without the need for general anesthesia, there are still some advantages of RF-TR over GKRS for refractory TN.…”

Section: Discussionmentioning

confidence: 99%

“…However, the major side effect of trigeminal nerve deficit is linked with a cumulative brainstem edge dose of >12 Gy ( P = .077) [40] . To date, there is no established cut-off for dose, and there was a tendency to decrease the dose at second GKRS in most studies to avoid dysfunction [36] .…”

Section: Discussionmentioning

confidence: 99%

Percutaneous radiofrequency trigeminal rhizotomy benefits in patients with refractory trigeminal neuralgia

Yang¹,

Lee²,

Yang³

et al. 2022

Medicine

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A significant number of patients suffers from refractory trigeminal neuralgia (TN) after receiving microvascular decompression (MVD) or other neuro-destructive procedure such as gamma knife radiosurgery (GKRS). This study aims to demonstrate a remediable, reproducible approach to treating refractory pain effectively by percutaneous radiofrequency trigeminal rhizotomy (RF-TR).A total of 392 patients with TN were treated by RF-TR during the past 10 years. Among these patients, 48 cases who had received either MVD, GKRS alone, or a combination of both were assigned to group A. Those who had not received any form of treatment (125 patients) or failed to respond medically (130 patients) were assigned as the control group (group B). All the RF-TR were performed by a single surgeon with the aid of intraoperative computed tomography (iCT)-based neuronavigation with magnetic resonance (MR) image fusion. The outcome measure was the numerical rating scale (NRS) expressed subjectively by patients. The paired Student t test and the analysis of covariance (ANCOVA) were used for statistical analysis.In group A, 21 of 24 patients (88%) had significant improvement (NRS change ≥5) in facial pain after RF-TR. The average NRS score was 9.75 ± 0.53 before the procedure and 1.92 ± 3.35 post-treatment (significant NRS decrease [P = .000]). On the other hand, in group B, 226 of 255 patients (89%) also had dramatic amelioration of facial pain after RF-TR. The average NRS score was 9.46 ± 0.69 before the procedure and 1.62 ± 2.85 post-treatment (7.84 ± 2.82 in NRS decrease [P = .008]). By using a univariate ANCOVA, no statistical significance was found in NRS score improvement between the two groups.Repeated MVD and GKRS for refractory TN may be less desirable due to a greater risk of mortality (up to 0.8%) and morbidity (4% of serious complications). Conversely, RF-TR administration with the novel navigation technique by using iCT and MR image fusion is free from any remarkable and irreversible morbidities. In this study, RF-TR not only provided an alternative and effective strategy if TN recurred but also resulted in the same NRS score improvement regardless of the status of prior treatment.

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“…Stereotactic radiosurgery is a painless successful alternative treatment for TN patients. [2][3][4][5][6][7][8][9] Sixty-nine percent of patients were reported to remain pain-free one year after GK surgery without additional medication. 10 GK has been the standard radiosurgery technique for trigeminal neuralgia treatments.…”

Section: Introductionmentioning

confidence: 99%

Assessing the Risk of Secondary Cancer Induction in Radiosensitive Organs During Trigeminal Neuralgia Treatment With Gamma Knife Radiosurgery: Impact of Extracranial Dose

Geraily,

Ameri,

Mahmoudi

et al. 2023

Dose-Response

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Purpose Gamma knife radiosurgery (GKRS) delivers high-dose external radiation to a small intracranial lesion. However, scattering and leaked radiation can deposit a portion of the dose outside the radiation field, which may pose a risk to radiation-sensitive patients, such as pregnant women. Trigeminal Neuralgia (TN) is treated with one of the highest GKRS doses (80–90 Gy). This study aimed to estimate the risk of secondary cancer induction in the uterus, ovaries, thyroid gland, and eyes of TN patients undergoing GKRS. Methods Radiation doses to the uterus, ovary, eyes, and thyroid gland were measured for 25 female TN patients, with a mean age of 35 years, utilizing Thermo Luminescent Dosimeters (TLD). Results The mean absorbed dose for the uterus, ovary, thyroid gland, and eyes were .63 ± .24, .471 ± .2, 8.26 ± 1.01, and 10.64 ± 1.08 cGy, respectively. Lifetime Attributable Risk (LAR) has been calculated using BEIR VII (2006) method. LAR for the uterus, ovary, and thyroid gland was 1, 2, and 23, respectively. Conclusion The results of this study and its comparison with standard values demonstrate that on average, mean doses to mentioned organs were smaller than their tolerance doses, and there is no limitation to treating patients suffering from TN by GK.

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Repeat Gamma-Knife Radiosurgery for Refractory or Recurrent Trigeminal Neuralgia with Consideration About the Optimal Second Dose

Cited by 17 publications

References 44 publications

Repeat Gamma Knife radiosurgery versus microvascular decompression following failure of GKRS in trigeminal neuralgia: a systematic review and meta-analysis

Repeat Gamma Knife radiosurgery versus microvascular decompression following failure of GKRS in trigeminal neuralgia: a systematic review and meta-analysis

Percutaneous radiofrequency trigeminal rhizotomy benefits in patients with refractory trigeminal neuralgia

Assessing the Risk of Secondary Cancer Induction in Radiosensitive Organs During Trigeminal Neuralgia Treatment With Gamma Knife Radiosurgery: Impact of Extracranial Dose

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