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CT-only planning for Gamma Knife radiosurgery in the treatment of trigeminal neuralgia: methodology and outcomes from a single institution.

https://arctichealth.org/en/permalink/ahliterature121715
Source
J Med Imaging Radiat Oncol. 2012 Aug;56(4):490-4
Publication Type
Article
Date
Aug-2012
Author
Albert Attia
Stephen B Tatter
Michael Weller
Kopriva Marshall
James F Lovato
J Daniel Bourland
Thomas L Ellis
Kevin P McMullen
Edward G Shaw
Michael D Chan
Author Affiliation
Department of Radiation Oncology Neurosurgery Biostatistics, Wake Forest University-Baptist Medical Center, Winston-Salem, NC, USA. aattia@wakehealth.edu
Source
J Med Imaging Radiat Oncol. 2012 Aug;56(4):490-4
Date
Aug-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Female
Humans
Male
Middle Aged
Radiosurgery - methods
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted - methods
Radiotherapy, Computer-Assisted - methods
Retrospective Studies
Surgery, Computer-Assisted - methods
Tomography, X-Ray Computed - methods
Treatment Outcome
Trigeminal Neuralgia - radiography - surgery
Abstract
Gamma Knife radiosurgery (GKRS) has been established as a safe and effective treatment option for trigeminal neuralgia. Some patients have contraindications to magnetic resonance imaging (MRI), the standard stereotactic imaging used for GKRS treatment planning. Computerized tomography (CT) imaging may be used as an alternative in this scenario. We sought to evaluate the outcomes of our patients treated using this technique.
Between August 2001 and November 2009, 19 patients with trigeminal neuralgia were treated with GKRS using CT-only planning. The course of the trigeminal nerve was determined based upon anatomical landmarks when the nerve was not directly visualized on the treatment-planning CT. Median dose used was 90 Gy (range 85-90 Gy). Follow-up data based on Barrow Neurological Institute (BNI) pain score and toxicity were obtained using electronic medical records and by telephone interview.
With median follow-up time of 18 months (range 4-36 months), improvement in quality of life after GKRS was reported in 17 of 19 patients. Freedom from BNI IV-V pain relapse was 82% at 24 months. By 3 months post-GKRS, 50% of patients were able to discontinue medications completely. Three patients reported numbness after GKRS; none of these patients described bothersome numbness. Use of contrast did not affect treatment outcome (P = 0.31).
Stereotactic CT-only treatment planning of GKRS for the treatment of trigeminal neuralgia is feasible and safe. Further studies are necessary to determine if the long-term durability of pain relief is comparable to that of MRI-based GKRS planning.
PubMed ID
22883661 View in PubMed
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Gamma knife radiosurgery in the treatment of tumor-related facial pain.

https://arctichealth.org/en/permalink/ahliterature125188
Source
Stereotact Funct Neurosurg. 2012;90(3):145-50
Publication Type
Article
Date
2012
Author
Sarah E Squire
Michael D Chan
R Michael Furr
Dorothy A Lowell
Stephen B Tatter
Thomas L Ellis
J Daniel Bourland
Allan F Deguzman
Michael T Munley
Kenneth E Ekstrand
Edward G Shaw
Kevin P McMullen
Author Affiliation
Department of Radiation Oncology, Wake Forest University, Winston-Salem, NC, USA. sarahsquire@gmail.com
Source
Stereotact Funct Neurosurg. 2012;90(3):145-50
Date
2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Brain Neoplasms - complications - surgery
Facial Pain - etiology - surgery
Female
Follow-Up Studies
Humans
Male
Meningioma - complications - surgery
Middle Aged
Neurilemmoma - complications - surgery
Pain Measurement
Radiosurgery - instrumentation
Retrospective Studies
Treatment Outcome
Abstract
Intracranial neoplasms can cause pain similar to trigeminal neuralgia. Literature regarding radiosurgery for this is limited. We present a retrospective review of patients with tumor-related facial pain from benign lesions treated with gamma knife radiosurgery (GKRS) at Wake Forest University.
The primary objectives were to determine long-term pain relief and predictive factors for pain alleviation.
We reviewed 515 patients treated with GKRS for benign meningioma, vestibular schwannoma or trigeminal schwannoma between August 1999 and August 2010. Twenty-one eligible patients had tumor-related facial pain prior to GKRS. The median marginal tumor dose was 12 Gy. Long-term pain relief data were obtained by chart review and telephone interview.
The median follow-up for symptom evaluation was 3.8 years. Seventeen of 21 patients (81%) experienced a Barrow Neurological Institute (BNI) score of I-III at 6 months following GKRS. Kaplan-Meier estimates of freedom from BNI IV-V relapse were 66% at 1 year and 53% at 2 years. No pain relapses occurred after 2 years.
GKRS of benign lesions is a noninvasive option for patients with tumor-related facial pain. Pain relief is modest, with the majority of pain relapses occurring within 2 years and approximately one half of patients maintaining relief beyond 2 years.
PubMed ID
22508112 View in PubMed
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Predictive nomogram for the durability of pain relief from gamma knife radiation surgery in the treatment of trigeminal neuralgia.

https://arctichealth.org/en/permalink/ahliterature104782
Source
Int J Radiat Oncol Biol Phys. 2014 May 1;89(1):120-6
Publication Type
Article
Date
May-1-2014
Author
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: johnthomas75@gmail.com.
Source
Int J Radiat Oncol Biol Phys. 2014 May 1;89(1):120-6
Date
May-1-2014
Language
English
Publication Type
Article
Keywords
Aged
Facial Pain - etiology - surgery
Female
Humans
Male
Middle Aged
Nomograms
Pain Management - methods
Pain Measurement - methods
Pain, Postoperative - therapy
Proportional Hazards Models
Radiosurgery - methods
Radiotherapy Dosage
Recurrence
Retrospective Studies
Time Factors
Trigeminal Neuralgia - surgery
Abstract
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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Predictive variables for the successful treatment of trigeminal neuralgia with gamma knife radiosurgery.

https://arctichealth.org/en/permalink/ahliterature132057
Source
Neurosurgery. 2012 Mar;70(3):566-72; discussion 572-3
Publication Type
Article
Date
Mar-2012
Author
Kopriva Marshall
Michael D Chan
Thomas P McCoy
Adam C Aubuchon
J Daniel Bourland
Kevin P McMullen
Allan F deGuzman
Michael T Munley
Edward G Shaw
Stephen B Tatter
Thomas L Ellis
Author Affiliation
Department of Radiation Oncology, Wake Forest University Health Sciences, Winston-Salem, North Carolina, USA.
Source
Neurosurgery. 2012 Mar;70(3):566-72; discussion 572-3
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Female
Follow-Up Studies
Humans
Male
Middle Aged
Multivariate Analysis
Postoperative Complications - epidemiology
Predictive value of tests
Radiation Dosage
Radiosurgery - adverse effects - statistics & numerical data
Risk factors
Treatment Outcome
Trigeminal Neuralgia - epidemiology - surgery
Young Adult
Abstract
Gamma Knife radiosurgery (GKRS) has been reported to be an effective modality to treat trigeminal neuralgia.
To determine predictive factors for the successful treatment of trigeminal neuralgia with GKRS.
Between 1999 and 2008, 777 GKRS procedures for patients with trigeminal neuralgia were performed at our institution. Evaluable follow-up data were obtained for 448 patients. Median follow-up time was 20.9 months (range, 3-86 months). The mean maximum prescribed dose was 88 Gy (range, 80-97 Gy). Dosimetric variables recorded included dorsal root entry zone dose, pons maximum dose, dose to the petrous dural ridge, and cisternal nerve length.
By 3 months after GKRS, 86% of patients achieved Barrow Neurologic Institute I to III pain scores, with 43% of patients achieving a Barrow Neurologic Institute I pain score. Twenty-six percent of patients reported posttreatment facial numbness; 28% of patients reported a post-GKRS procedure for relapsed pain, and median time to next procedure was 4.4 years. Multivariate analysis revealed that the development of postsurgical numbness (odds ratio [OR], 2.76; P = .006) was the dominant factor predictive of efficacy. Longer cisternal nerve length (OR, 0.85; P = .005), prior radiofrequency ablation (OR, 0.35; P = .028), and diabetes mellitus (OR, 0.38; P = .013) predicted decreased efficacy. The mean dose delivered to the dorsal root entry zone dose in patients who developed facial numbness (57.6 Gy) was more than the mean dose (47.3 Gy) given to patients who did not develop numbness (P = .02).
The development of post-GKRS facial numbness is a dominant factor that predicts for efficacy of GKRS. History of diabetes mellitus or previous radiofrequency ablation may portend worsened outcome.
PubMed ID
21849918 View in PubMed
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Single-institution retrospective series of gamma knife radiosurgery in the treatment of multiple sclerosis-related trigeminal neuralgia: factors that predict efficacy.

https://arctichealth.org/en/permalink/ahliterature106224
Source
Stereotact Funct Neurosurg. 2014;92(1):53-8
Publication Type
Article
Date
2014
Author
Michael Weller
Kopriva Marshall
James F Lovato
J Daniel Bourland
Allan F deGuzman
Michael T Munley
Edward G Shaw
Stephen B Tatter
Michael D Chan
Author Affiliation
Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, USA.
Source
Stereotact Funct Neurosurg. 2014;92(1):53-8
Date
2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Multiple Sclerosis - complications
Multivariate Analysis
North Carolina
Radiosurgery
Retrospective Studies
Treatment Outcome
Trigeminal Neuralgia - etiology - surgery
Abstract
Gamma knife radiosurgery (GKRS) has been reported as a treatment option for multiple sclerosis (MS)-related trigeminal neuralgia.
To report the outcomes of a single-institution retrospective series of MS-related trigeminal neuralgia.
Between 2002 and 2010, 35 patients with MS-related trigeminal neuralgia were treated with GKRS. The median maximum dose was 90 Gy. Data were analyzed to determine the response to GKRS and factors that may predict for efficacy.
Of the 35 patients, 88% experienced a Barrow Neurological Institute (BNI) pain score of I-III at 3 months after GKRS. Kaplan-Meier estimates of 1-, 2- and 5-year freedom from BNI IV-V pain relapse were 57, 57 and 52%, respectively. Numbness was experienced by 39% of patients after GKRS, though no patients reported bothersome numbness. Several differences were noted between how the MS-related variant responded to GKRS and what has previously been reported for idiopathic trigeminal neuralgia. These include the observations that development of post-GKRS numbness did not predict for treatment response (p = 0.62) and that dorsal root entry zone dose did not predict for freedom from pain relapse (odds ratio 1.01, p = 0.1). Active smoking predicted for freedom from pain relapse (odds ratio 67.4, p = 0.04).
GKRS is a viable noninvasive treatment option for MS-related trigeminal neuralgia.
PubMed ID
24217153 View in PubMed
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