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Predictive nomogram for the durability of pain relief from gamma knife radiation surgery in the treatment of trigeminal neuralgia.
Int J Radiat Oncol Biol Phys. 2014 May 1;89(1):120-6
Publication Type
John T Lucas
Adrian M Nida
Scott Isom
Kopriva Marshall
John D Bourland
Adrian W Laxton
Stephen B Tatter
Michael D Chan
Author Affiliation
Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina. Electronic address:
Int J Radiat Oncol Biol Phys. 2014 May 1;89(1):120-6
Publication Type
Facial Pain - etiology - surgery
Middle Aged
Pain Management - methods
Pain Measurement - methods
Pain, Postoperative - therapy
Proportional Hazards Models
Radiosurgery - methods
Radiotherapy Dosage
Retrospective Studies
Time Factors
Trigeminal Neuralgia - surgery
To determine factors associated with the durability of stereotactic radiation surgery (SRS) for treatment of trigeminal neuralgia (TN).
Between 1999 and 2008, 446 of 777 patients with TN underwent SRS and had evaluable follow-up in our electronic medical records and phone interview records. The median follow-up was 21.2 months. The Barrow Neurologic Institute (BNI) pain scale was used to determine pre- and post-SRS pain. Dose-volume anatomical measurements, Burchiel pain subtype, pain quality, prior procedures, and medication usage were included in this retrospective cohort to identify factors impacting the time to BNI 4-5 pain relapse by using Cox proportional hazard regression. An internet-based nomogram was constructed based on predictive factors of durable relief pre- and posttreatment at 6-month intervals.
Rates of freedom from BNI 4-5 failure at 1, 3, and 5 years were 84.5%, 70.4%, and 46.9%, respectively. Pain relief was BNI 1-3 at 1, 3, and 5 years in 86.1%, 74.3%, and 51.3% of type 1 patients; 79.3%, 46.2%, and 29.3% of type 2 patients; and 62.7%, 50.2%, and 25% of atypical facial pain patients. BNI type 1 pain score was achieved at 1, 3, and 5 years in 62.9%, 43.5%, and 22.0% of patients with type 1 pain and in 47.5%, 25.2%, and 9.2% of type 2 patients, respectively. Only 13% of patients with atypical facial pain achieved BNI 1 response; 42% of patients developed post-Gamma Knife radiation surgery (GKRS) trigeminal dysfunction. Multivariate analysis revealed that post-SRS numbness (hazard ratio [HR], 0.47; P
PubMed ID
24613811 View in PubMed
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