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

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Gamma Knife Neurosurgery in the Management of Intracranial Disorders

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 116))

Abstract

Background: Gamma knife surgery (GKS) is the prevailing method for treatment of medically intractable trigeminal neuralgia (TN), although there are some technical differences among radiosurgical centers. We assessed the long-term outcomes of GKS using retrogasserian petrous bone targeting and evaluated factors associated with the clinical outcomes.

Methods: Between December 2003 and June 2009, a total of 91 GKS treatments were performed in 90 patients with classic TN. The surgical target was defined at the anterior portion of the trigeminal nerve, just above the retrogasserian petrous bone. A single 4-mm collimator was used to deliver a median 88.0 Gy (range 75–90 Gy) dose of radiation.

Findings: During follow-up, which ranged from 24 to 90 months, 89 patients (97.8 %) reported initial pain relief, 75 (82.4 %) experienced pain control, and 47 (51.6 %) achieved a pain-free state without medications at the last follow-up. Barrow Neurological Institute (BNI) scores of I–III at 2, 3, 4, 5, and 7 years were observed in 84 of 91, 68 of 77, 46 of 53, 33 of 36, 17 of 19, and 7 of 7 patients, respectively. Trigeminal nerve dysfunction was experienced by 34 patients, with 12 having BNI facial numbness scores of III–IV (13.2 %). In all, 14 patients (15.4 %) experienced pain recurrence at a mean 32 months (range 10–62 months) after treatment. The actuarial rates of pain control at 2, 4, and 6 years were 93 %, 88 %, and 79 %, respectively.

Conclusions: Gamma Knife radiosurgery is an efficient option for intractable TN. Our results can help medical practitioners to counsel their patients on the likelihood of achieving successful pain control.

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References

  1. Barker FG, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD (1996) The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334:1077–1083

    Article  PubMed  Google Scholar 

  2. Brisman R (2004) Gamma knife surgery with a dose of 75 to 76.8 Gray for trigeminal neuralgia. J Neurosurg 100:848–854

    Article  PubMed  Google Scholar 

  3. Fields HL (1996) Treatment of trigeminal neuralgia. N Engl J Med 334:1125–1126

    Article  PubMed  CAS  Google Scholar 

  4. Flickinger JC, Pollock BE, Kondziolka D, Phuong LK, Foote RL, Stafford SL, Lunsford LD (2001) Does increased nerve length within the treatment volume improve trigeminal neuralgia ­radiosurgery? A prospective double-blind, randomized study. Int J Radiat Oncol Biol Phys 51:449–454

    Article  PubMed  CAS  Google Scholar 

  5. Fountas KN, Lee GP, Smith JR (2006) Outcome of patients undergoing gamma knife stereotactic radiosurgery for medically refractory idiopathic trigeminal neuralgia: Medical College of Georgia’s experience. Stereotact Funct Neurosurg 84:88–96

    Article  PubMed  Google Scholar 

  6. Greenberg M (1997) Handbook of neurosurgery, 4th edn. Greenberg Graphics, Lakeland, 964 p

    Google Scholar 

  7. Gronseth G, Cruccu G, Alksne J, Argoff C, Brainin M, Burchiel K, Nurmikko T, Zakrzewska JM (2008) Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the European Federation of Neurological Societies. Neurology 71:1183–1190

    Article  PubMed  CAS  Google Scholar 

  8. Guo S, Chao ST, Reuther AM, Barnett GH, Suh JH (2008) Review of the treatment of trigeminal neuralgia with gamma knife radiosurgery. Stereotact Funct Neurosurg 86:135–146

    Article  PubMed  Google Scholar 

  9. Hayashi M, Chernov M, Tamura N, Taira T, Izawa M, Yomo S, Nagai M, Chang CS, Ivanov P, Tamura M, Muragaki Y, Okada Y, Iseki H, Takakura K (2011) Stereotactic radiosurgery of essential trigeminal neuralgia using Leksell Gamma Knife model C with automatic positioning system: technical nuances and evaluation of outcome in 130 patients with at least 2 years follow-up after treatment. Neurosurg Rev 34:497–508

    Article  PubMed  Google Scholar 

  10. Kitt CA, Gruber K, Davis M, Woolf CJ, Levine JD (2000) Trigeminal neuralgia: opportunities for research and treatment. Pain 85:3–7

    Article  PubMed  CAS  Google Scholar 

  11. Kondziolka D, Lunsford LD, Flickinger JC, Young RF, Vermeulen S, Duma CM, Jacques DB, Rand RW, Regis J, Peragut JC, Manera L, Epstein MH, Lindquist C (1996) Stereotactic radiosurgery for trigeminal neuralgia: a multiinstitutional study using the gamma unit. J Neurosurg 84:940–945

    Article  PubMed  CAS  Google Scholar 

  12. Kondziolka D, Zorro O, Lobato-Polo J, Kano H, Flannery TJ, Flickinger JC, Lunsford LD (2010) Gamma Knife stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 112:758–765

    Article  PubMed  Google Scholar 

  13. Koopman JS, de Vries LM, Dieleman JP, Huygen FJ, Stricker BH, Sturkenboom MC (2011) A nationwide study of three invasive treatments for trigeminal neuralgia. Pain 152:507–513

    Article  PubMed  Google Scholar 

  14. Leksell L (1968) Cerebral radiosurgery. I. Gammathalanotomy in two cases of intractable pain. Acta Chir Scand 134:585–595

    PubMed  CAS  Google Scholar 

  15. Leksell L (1971) Sterotaxic radiosurgery in trigeminal neuralgia. Acta Chir Scand 137:311–314

    PubMed  CAS  Google Scholar 

  16. Lindquist C, Kihlstrom L, Hellstrand E (1991) Functional neurosurgery – a future for the gamma knife? Stereotact Funct Neurosurg 57:72–81

    Article  PubMed  CAS  Google Scholar 

  17. Little AS, Shetter AG, Shetter ME, Bay C, Rogers CL (2008) Long-term pain response and quality of life in patients with typical trigeminal neuralgia treated with gamma knife stereotactic radiosurgery. Neurosurgery 63:915–924

    Article  PubMed  Google Scholar 

  18. Maesawa S, Salame C, Flickinger JC, Pirris S, Kondziolka D, Lunsford LD (2001) Clinical outcomes after stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 94:14–20

    Article  PubMed  CAS  Google Scholar 

  19. Massager N, Lorenzoni J, Devriendt D, Desmedt F, Brotchi J, Levivier M (2004) Gamma knife surgery for idiopathic trigeminal neuralgia performed using a far-anterior cisternal target and a high dose of radiation. J Neurosurg 100:597–605

    Article  PubMed  Google Scholar 

  20. Massager N, Nissim O, Murata N, Devriendt D, Desmedt F, Vanderlinden B, Regis J, Levivier M (2006) Effect of beam channel plugging on the outcome of gamma knife radiosurgery for trigeminal neuralgia. Int J Radiat Oncol Biol Phys 65:1200–1205

    Article  PubMed  Google Scholar 

  21. Matsuda S, Serizawa T, Nagano O, Ono J (2008) Comparison of the results of 2 targeting methods in Gamma Knife surgery for trigeminal neuralgia. J Neurosurg 109(Suppl):185–189

    PubMed  Google Scholar 

  22. Matsuda S, Serizawa T, Sato M, Ono J (2002) Gamma knife ­radiosurgery for trigeminal neuralgia: the dry-eye complication. J Neurosurg 97:525–528

    Article  PubMed  Google Scholar 

  23. McNatt SA, Yu C, Giannotta SL, Zee CS, Apuzzo ML, Petrovich Z (2005) Gamma knife radiosurgery for trigeminal neuralgia. Neurosurgery 56:1295–1303

    Article  PubMed  Google Scholar 

  24. Merskey H, Bogduk N (1994) Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. IASP Press, Seattle, pp 59–71

    Google Scholar 

  25. Nicol B, Regine WF, Courtney C, Meigooni A, Sanders M, Young B (2000) Gamma knife radiosurgery using 90 Gy for trigeminal neuralgia. J Neurosurg 93((Suppl) 3):152–154

    PubMed  Google Scholar 

  26. Park SH, Hwang SK, Kang DH, Park J, Hwang JH, Sung JK (2010) The retrogasserian zone versus dorsal root entry zone: comparison of two targeting techniques of gamma knife radiosurgery for trigeminal neuralgia. Acta Neurochir (Wien) 152:1165–1170

    Article  Google Scholar 

  27. Petit JH, Herman JM, Nagda S, DiBiase SJ, Chin LS (2003) Radiosurgical treatment of trigeminal neuralgia: evaluating quality of life and treatment outcomes. Int J Radiat Oncol Biol Phys 56:1147–1153

    Article  PubMed  Google Scholar 

  28. Pollock BE, Ecker RD (2005) A prospective cost-effectiveness study of trigeminal neuralgia surgery. Clin J Pain 21:317–322

    Article  PubMed  Google Scholar 

  29. Pollock BE, Phuong LK, Foote RL, Stafford SL, Gorman DA (2001) High-dose trigeminal neuralgia radiosurgery associated with increased risk of trigeminal nerve dysfunction. Neurosurgery 49:58–64

    PubMed  CAS  Google Scholar 

  30. Pollock BE, Phuong LK, Gorman DA, Foote RL, Stafford SL (2002) Stereotactic radiosurgery for idiopathic trigeminal ­neuralgia. J Neurosurg 97:347–353

    Article  PubMed  Google Scholar 

  31. Rand RW (1997) Leksell Gamma Knife treatment of tic ­douloureux. Neurosurg Clin N Am 8:75–78

    PubMed  CAS  Google Scholar 

  32. Rand RW, Jacques DB, Melbye RW, Copcutt BG, Levenick MN, Fisher MR (1993) Leksell Gamma Knife treatment of tic ­douloureux. Stereotact Funct Neurosurg 61(Suppl 1):93–102

    Article  PubMed  Google Scholar 

  33. Regis J (2002) High-dose trigeminal neuralgia radiosurgery associated with increased risk of trigeminal nerve dysfunction. Neurosurgery 50:1401–1402; author reply 1402–1403

    Article  PubMed  Google Scholar 

  34. Regis J, Arkha Y, Yomo S, Murata N, Roussel P, Donnet A, Peragut JC (2009) Radiosurgery in trigeminal neuralgia: long-term results and influence of operative nuances. Neurochirurgie 55:213–222 (in French)

    Article  PubMed  CAS  Google Scholar 

  35. Regis J, Metellus P, Hayashi M, Roussel P, Donnet A, Bille-Turc F (2006) Prospective controlled trial of gamma knife surgery for essential trigeminal neuralgia. J Neurosurg 104:913–924

    Article  PubMed  Google Scholar 

  36. Young RF, Vermeulen SS, Grimm P, Blasko J, Posewitz A (1997) Gamma Knife radiosurgery for treatment of trigeminal neuralgia: idiopathic and tumor related. Neurology 48:608–614

    Article  PubMed  CAS  Google Scholar 

  37. Zakrzewska JM, Jassim S, Bulman JS (1999) A prospective, longitudinal study on patients with trigeminal neuralgia who underwent radiofrequency thermocoagulation of the Gasserian ganglion. Pain 79:51–58

    Article  PubMed  CAS  Google Scholar 

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Conflict of Interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Neurosurgery, Asan Medical Center, University of Ulsan, College of Medicine, 88, Olympic Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea

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

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  1. Jung Kyo Lee
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  2. Deok Ryeong Kim
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  3. Yeon Hee Huh
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  4. Jin Kyung Kim
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  5. Won Chul Namgung
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Corresponding author

Correspondence to Jung Kyo Lee .

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Editors and Affiliations

  1. , Fac. of Adv. Techno-Surgery, Tokyo Women's Medical University, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Mikhail F. Chernov

  2. , Dept. of Neurosurgery, Tokyo Women's Medical University, Kawada-cho, Shinjuku-ku 8-1, Tokyo, 162-8666, Japan

    Motohiro Hayashi

  3. Oysteinsgate 16, Bergen, 5007, Norway

    Jeremy C. Ganz

  4. Kawada-cho, Shinjuku-ku 8-1, JP-162 8666 TOKYO, Japan

    Kintomo Takakura

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Lee, J.K., Kim, D.R., Huh, Y.H., Kim, J.K., Namgung, W.C., Hong, S.H. (2013). Long-Term Outcome of Gamma Knife Surgery Using a Retrogasserian Petrous Bone Target for Classic Trigeminal Neuralgia. In: Chernov, M., Hayashi, M., Ganz, J., Takakura, K. (eds) Gamma Knife Neurosurgery in the Management of Intracranial Disorders. Acta Neurochirurgica Supplement, vol 116. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1376-9_20

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  • DOI: https://doi.org/10.1007/978-3-7091-1376-9_20

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