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Computed tomography-guided ? knife stereotactic radiosurgery for trigeminal neuralgia.

https://arctichealth.org/en/permalink/ahliterature134833
Source
Acta Neurochir (Wien). 2011 Aug;153(8):1601-9
Publication Type
Article
Date
Aug-2011
Author
Kyung-Jae Park
Hideuki Kano
Oren Berkowitz
Nasir R Awan
John C Flickinger
L Dade Lunsford
Douglas Kondziolka
Author Affiliation
Department of Neurological Surgery, University of Pittsburgh, Center for Image-Guided Neurosurgery, Suite B-400, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
Source
Acta Neurochir (Wien). 2011 Aug;153(8):1601-9
Date
Aug-2011
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Female
Humans
Male
Middle Aged
Radiation Dosage
Radiosurgery - methods
Retrospective Studies
Stereotaxic Techniques - instrumentation
Tomography, X-Ray Computed - methods
Treatment Outcome
Trigeminal Nerve - radiography - surgery
Trigeminal Neuralgia - surgery
Abstract
Gamma knife stereotactic radiosurgery (GKSR) is an effective minimally invasive option for the treatment of medically refractory trigeminal neuralgia (TN). Optimal targeting of the retrogasserian trigeminal nerve target requires thin-slice, high-definition stereotactic magnetic resonance imaging (MRI). The purpose of this study was to evaluate management outcomes in TN patients ineligible for MRI and who instead underwent GKSR using computed tomography (CT).
The authors reviewed their experience with CT-guided GKSR in 21 patients (median age: 75 years) with idiopathic TN. Contraindications to MRI included implanted pacemakers (n?=?16), aneurysm clips (n?=?2), cochlea implants (n?=?1), metallic vascular stents (n?=?1) or severe obesity (weight of 163 kg, n?=?1). Contrast-enhanced CT at 1- or 1.25-mm intervals was acquired in all patients. One patient also underwent CT cisternography. The median target dose for GKSR was 80 Gy. The median follow-up was 35 months after GKSR. Treatment outcomes were compared to 459 patients who underwent MRI-guided GKSR for TN at our institute in the same time interval.
Targeting of the trigeminal nerve guided by CT scan was feasible in all patients. Stereotactic frame titanium pin-related artifacts that interfered with full visualization of the trigeminal nerve were found in one patient who had the ipsilateral posterior pin placed near the inion. After GKSR, 90% of patients achieved initial pain relief that was adequate or better, with or without medication (Barrow Neurological Institute pain scores I-IIIb). Median time to pain relief was 2.6 weeks. Pain relief was maintained in 81% at 1 year, 66% at 2 years, and 46% at 5 years. Eight (42%) of 19 patients who achieved initial pain relief reported some recurrent pain at a median of 18 months after GKSR. Some degree of facial sensory dysfunction occurred in 19% of patients within 24 months of GKSR. These results are comparable to those of patients who had MRI-guided GKSR.
CT-guided GKSR provides a similar rate of pain relief as MRI-guided radiosurgery. The posterior pins should be placed at least 1 cm away from the inion to reduce pin and frame-related artifacts on the targeting CT scan. This study indicates that GKSR using CT targeting is appropriate for patients with medically refractory TN who are unsuitable for MRI.
PubMed ID
21538196 View in PubMed
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CyberKnife radiosurgery as a first treatment for idiopathic trigeminal neuralgia.

https://arctichealth.org/en/permalink/ahliterature152934
Source
Neurosurgery. 2009 Feb;64(2 Suppl):A96-101
Publication Type
Article
Date
Feb-2009
Author
Laura Fariselli
Carlo Marras
Michela De Santis
Marcello Marchetti
Ida Milanesi
Giovanni Broggi
Author Affiliation
Division of Radiotherapy, Fondazione Istituto Neurologico C. Besta, and Centro Diagnostico Italiano, Milan, Italy.
Source
Neurosurgery. 2009 Feb;64(2 Suppl):A96-101
Date
Feb-2009
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Facial Pain - etiology - surgery
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Paresthesia - etiology
Radiosurgery - adverse effects - methods
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted
Tongue - radiation effects
Treatment Outcome
Trigeminal Neuralgia - surgery
Abstract
To report the level of effectiveness and safety, in our experience, of CyberKnife (Accuray, Inc., Sunnyvale, CA) robotic radiosurgery as a first-line treatment against pharmacologically refractory trigeminal neuralgia.
We treated 33 patients with the frameless CyberKnife system as a monotherapy. The retrogasserian portion of the trigeminal nerve (a length of 4 mm, 2-3 mm anterior to the root entry zone) was targeted. Doses of 55 to 75 Gy were prescribed to the 100% isodose line, according to a dose escalation protocol. The patients were evaluated for the level of pain control, time to pain relief, hypesthesia, and time to pain recurrence.
The median age was 74 years. All but 2 patients (94%) achieved a successful treatment outcome. The follow-up period was 9 to 37 months (mean, 23 months). The Barrow Neurological Institute Pain Intensity Scale (BPS) score before radiosurgery was III in 2 patients (6%), IV in 8 patients (24%), and V in 23 patients (70%). The time to pain relief was 1 to 180 days (median, 30 days). No facial numbness was observed. Only 1 patient developed a transitory dysesthesia of the tongue. After treatment, the BPS score was I, II, or III in 31 patients (97%). Pain recurred in 33% (11 patients) at a mean of 9 months (range, 1-43 months). Three patients with recurrences had low pain control by medication (BPS score, IV), and 1 patient (BPS score, V) needed a radiofrequency lesioning (BPS score, I at 12 months).
CyberKnife radiosurgery for trigeminal neuralgia allows pain relief at safe doses and is suggested for pharmacologically refractory trigeminal neuralgia. Higher prescribed doses were not associated with improvement in pain relief or recurrence rate.
PubMed ID
19165081 View in PubMed
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Cyberknife stereotactic radiosurgical rhizotomy for trigeminal neuralgia: anatomic and morphological considerations.

https://arctichealth.org/en/permalink/ahliterature152935
Source
Neurosurgery. 2009 Feb;64(2 Suppl):A91-5
Publication Type
Article
Date
Feb-2009
Author
John D Borchers
Hee-Jin Yang
Gordon T Sakamoto
Gregory A Howes
Gaurav Gupta
Steven D Chang
John R Adler
Author Affiliation
Department of Neurosurgery, Stanford University Medical Center, Stanford, California 94305, USA.
Source
Neurosurgery. 2009 Feb;64(2 Suppl):A91-5
Date
Feb-2009
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Female
Humans
Hypesthesia - etiology
Magnetic Resonance Imaging
Male
Middle Aged
Radiosurgery - adverse effects
Retrospective Studies
Rhizotomy - methods
Treatment Outcome
Trigeminal Nerve - anatomy & histology
Trigeminal Neuralgia - surgery
Abstract
To search for correlations between specific anatomic, geometric, and morphological properties of the trigeminal nerve and the success of radiosurgical treatment and elimination of facial hypesthesia as a complication.
Forty-six patients with at least 6 months of follow-up after CyberKnife (Accuray, Inc., Sunnyvale, CA) rhizotomy were retrospectively reviewed. Patients treated after 2004 were entered into the study after congruity in treatment parameters was established. Anatomic variations regarding the length of each nerve segment and angle of trigeminal nerve takeoff from brainstem to Meckel's cave in the axial and sagittal planes were studied. Dose distribution to surrounding critical structures (brainstem and trigeminal ganglion) was measured. After spatial relationships of involved structures and dose distributions were recorded, their relationship to treatment success, failure, or complication (primarily facial numbness) was tabulated.
Forty-five patients (97.2%) experienced pain relief immediately or within weeks. Thirty-four patients maintained excellent outcome. Some degree of facial numbness developed in 18 patients (39.1%) and was mild in 11 of them (Grade II on the Barrow Neurological Institute scale). Patients with a sagittal-angle trigeminal nerve takeoff from the brainstem in the range of 150 to 170 degrees measured from the horizontal plane had a more favorable outcome (P = 0.03) than patients with less obtuse relationships to the proximal nerve origin. Patients who received higher doses of radiation to the brainstem/dorsal root entry zone of the trigeminal nerve experienced a higher rate of posttreatment facial anesthesia.
There may be important anatomic and geometric relationships between the treated trigeminal nerve and surrounding critical structures that warrant pretreatment target volume placement and dose distribution considerations.
PubMed ID
19165080 View in PubMed
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Does the Gamma Knife dose rate affect outcomes in radiosurgery for trigeminal neuralgia?

https://arctichealth.org/en/permalink/ahliterature138794
Source
J Neurosurg. 2010 Dec;113 Suppl:168-71
Publication Type
Article
Date
Dec-2010
Author
Yoshio Arai
Hideyuki Kano
L Dade Lunsford
Josef Novotny
Ajay Niranjan
John C Flickinger
Douglas Kondziolka
Author Affiliation
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
Source
J Neurosurg. 2010 Dec;113 Suppl:168-71
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Chi-Square Distribution
Dose-Response Relationship, Radiation
Female
Half-Life
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Pain Measurement
Radiosurgery - instrumentation
Radiotherapy Dosage
Retrospective Studies
Treatment Outcome
Trigeminal Neuralgia - surgery
Abstract
The object of this study was to determine whether the radiation dose rate affects clinical outcomes in patients who undergo stereotactic Gamma Knife surgery (GKS) to manage typical trigeminal neuralgia (TN).
The authors retrospectively studied pain relief in 165 patients with medically intractable TN, who underwent 80-Gy GKS using a single 4-mm collimator between 1994 and 2005. No patient had received prior radiation treatment. The measured relative helmet output factor of the Gamma Knife was 0.8 throughout this interval, and the dose rate varied from 1.21 Gy/minute to 3.74 Gy/minute (median 2.06 Gy/minute). Irradiation time varied from 26.73 to 95.11 minutes. The authors divided patients into a low-dose-rate (LDR) group, in which the dose rate varied from 1.21 to 2.05 Gy/minute, and a high-dose-rate (HDR) group, in which the dose rate varied from 2.06 to 3.74 Gy/minute. Post-GKS, the patients' pain control was determined using the Barrow Neurological Institute (BNI) pain scale. There was no statistically significant difference between groups with respect to history of prior microvascular decompression (p = 0.410) or peripheral neuroablative procedures (p = 0.583). The length of symptoms in patients varied from 3 to 414 months with a median of 84 months (p = 0.698). Median follow-up was 26 months with a maximum of 139 months.
Initial pain relief was obtained in 71% of patients in the LDR group and 78% in the HDR group (p = 0.547). Patients who initially obtained improved pain relief (BNI Scores I-IIIa) after GKS maintained pain control for median durations of 52 months (LDR group) and 54 months (HDR group) (p = 0.403). New or increased facial sensory dysfunction was found in 14.5% of patients in the LDR group and in 19.3% of patients in the HDR group (p = 0.479).
The authors found that the GKS dose rate did not affect pain control or morbidity within the range of 1.21-3.74 Gy/minute. Cobalt 60 source decay did not affect outcomes of GKS for TN pain management, even for dose rates approximating a 2-half-life decay of the isotope.
PubMed ID
21121798 View in PubMed
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Endoscopic vascular decompression for the treatment of trigeminal neuralgia: clinical outcomes and technical note.

https://arctichealth.org/en/permalink/ahliterature106594
Source
World Neurosurg. 2014 Mar-Apr;81(3-4):603-8
Publication Type
Article
Author
Pradeep Setty
Andrey A Volkov
Kenneth P D'Andrea
Daniel R Pieper
Author Affiliation
Section of Neurosurgery, St. John Providence Hospital and Medical Centers, Michigan State University, Southfield, Michigan, USA. Electronic address: DrPSetty@gmail.com.
Source
World Neurosurg. 2014 Mar-Apr;81(3-4):603-8
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cerebellopontine Angle - surgery
Cerebellum - blood supply
Cerebral Arteries - surgery
Female
Humans
Kaplan-Meier Estimate
Length of Stay
Male
Microvascular Decompression Surgery - methods
Middle Aged
Neuroendoscopy - methods
Operative Time
Prospective Studies
Skull Base - surgery
Treatment Outcome
Trigeminal Neuralgia - surgery
Abstract
This study sought to describe the operative technique and clinical outcomes in a series of 57 patients with trigeminal neuralgia treated with endoscopic vascular decompression (EVD) alone without the use of microscopy at any point.
A prospective observational study was performed on 57 consecutive patients treated with EVD alone for trigeminal neuralgia from October 2005 to October 2010. Patient outcomes were evaluated with respect to pain abatement, complication rate, length of hospital stay, and overall operative time. Pain outcome was graded using the Barrow Neurological Institute pain intensity score (BNI), with BNI 1 considered an excellent result and BNI 2 or 3 considered a good result. Follow-up ranged from 12 to 72 months, with a mean of 32 months. In addition to reporting these cases, our operative technique for EVD is described in detail.
All 57 patients reported severe preoperative pain (BNI 5); 100% of patients achieved immediate postoperative pain control or complete pain relief (BNI 1 to 3), with 82% obtaining an excellent result of BNI 1, and 18% of patients reported good results of BNI 2 or 3. At follow-up, 56 of 57 patients (98%) reported complete relief or well controlled pain (BNI 1 to 3), with 75% obtaining an excellent result of BNI 1; 23% of patients obtained a good result of BNI 2 or 3. The complication rate was 4%, with no mortality. Mean length of hospital stay was 1.6 days, with a range of 1 to 5 days; mean operative time was 133 minutes.
EVD is a safe and highly effective alternative to the more traditional open microvascular decompression or the more recently developed endoscopically assisted microvascular decompression.
Notes
Comment In: World Neurosurg. 2014 Mar-Apr;81(3-4):499-50024215870
PubMed ID
24140999 View in PubMed
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Gamma knife radiosurgery for trigeminal neuralgia.

https://arctichealth.org/en/permalink/ahliterature174563
Source
Neurosurgery. 2005 Jun;56(6):1295-301; discussion 1301-3
Publication Type
Article
Date
Jun-2005
Author
Sean A McNatt
Cheng Yu
Steven L Giannotta
Chi-Shing Zee
Michael L J Apuzzo
Zbigniew Petrovich
Author Affiliation
Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA. mcnatt@usc.edu
Source
Neurosurgery. 2005 Jun;56(6):1295-301; discussion 1301-3
Date
Jun-2005
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Female
Follow-Up Studies
Humans
Male
Middle Aged
Radiosurgery - methods
Retrospective Studies
Stereotaxic Techniques
Time Factors
Treatment Outcome
Trigeminal Neuralgia - surgery
Abstract
The purpose of this study was to assess outcomes in patients treated with gamma knife radiosurgery for trigeminal neuralgia.
From 1997 to 2003, a total of 49 patients with trigeminal neuralgia underwent gamma knife radiosurgery. The trigeminal root entry zone immediately adjacent to the pons was targeted by use of a 4-mm collimator to deliver 40 Gy to the 50% isodose line (maximum dose, 80 Gy). Special care was taken to limit radiation dose to the adjacent pons to 12 Gy. Of the 49 study patients, all had undergone previous medical therapy, 8 (16%) had undergone microvascular decompression, 8 (16%) had undergone percutaneous rhizotomy, 2 (4%) had undergone linear accelerator-based radiosurgery, and 5 (10%) presented with multiple sclerosis. The median duration of symptoms was 6 years. There were 29 female patients (59%) and 20 male patients (41%). Facial pain outcomes were assessed by use of the Barrow Neurological Institute pain score. Other outcomes assessed included recurrence of symptoms and treatment toxicity. The median follow-up period was 49 months.
At last evaluation, a total of 27 patients (61%) with idiopathic trigeminal neuralgia reported pain relief (scores of IIIb or less). This included 14 patients (32%) who reported complete pain relief when not receiving medications. Significant recurrence of pain after an initial interval of relief was reported by 10 patients (23%). Mean time to pain recurrence was 9.6 months (range, 2-36 mo). Mild to moderate facial numbness was experienced by 13 patients (29%), whereas 8 (18%) reported mild dysesthesias.
Gamma knife radiosurgery established durable pain relief in 61% of patients with medically refractory idiopathic trigeminal neuralgia. A longer follow-up period is necessary to fully assess the incidence of late complications and recurrences.
PubMed ID
15918946 View in PubMed
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Gamma knife radiosurgery for trigeminal neuralgia: experience at the Barrow Neurological Institute.

https://arctichealth.org/en/permalink/ahliterature198236
Source
Stereotact Funct Neurosurg. 1999;73(1-4):131-3
Publication Type
Article
Date
1999
Author
P P Han
A G Shetter
K A Smith
J A Fiedler
C L Rogers
B. Speiser
I. Feiz-Erfan
Author Affiliation
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013-4496, USA.
Source
Stereotact Funct Neurosurg. 1999;73(1-4):131-3
Date
1999
Language
English
Publication Type
Article
Keywords
Aged
Female
Follow-Up Studies
Humans
Male
Middle Aged
Postoperative Complications
Questionnaires
Radiosurgery
Retrospective Studies
Treatment Outcome
Trigeminal Neuralgia - surgery
Abstract
Forty-three patients with trigeminal neuralgia (TN) unresponsive to pharmacologic treatment and/or prior invasive procedures underwent stereotactic radiosurgery with the Gamma Knife (GK). Outcome was evaluated by a standardized questionnaire mailed to each patient. The mean follow-up was 9 months. Fifteen patients (35%) reported no trigeminal pain and were no longer taking medication. Three patients (7%) experienced occasional pain, but were no longer taking medication. In 15 patients (35%), pain improved and was adequately controlled by medication, often in lower dosages than preoperatively. Pain was reduced in 9 patients (21%), but their symptoms were still inadequately controlled by drug therapy, and 1 patient (2%) reported no pain relief after treatment. Three patients (7%) described new facial numbness, but in none was this bothersome. GK radiosurgery for TN appears to have minimal morbidity, although the success rate may be slightly lower than that of other operative procedures. More patients and longer follow-up are needed before drawing final conclusions regarding efficacy and complications.
PubMed ID
10853118 View in PubMed
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Gamma Knife stereotactic radiosurgery for idiopathic trigeminal neuralgia.

https://arctichealth.org/en/permalink/ahliterature148600
Source
J Neurosurg. 2010 Apr;112(4):758-65
Publication Type
Article
Date
Apr-2010
Author
Douglas Kondziolka
Oscar Zorro
Javier Lobato-Polo
Hideyuki Kano
Thomas J Flannery
John C Flickinger
L Dade Lunsford
Author Affiliation
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA. kondziolkads@upmc.edu
Source
J Neurosurg. 2010 Apr;112(4):758-65
Date
Apr-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Causalgia
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Pain, Postoperative
Paresthesia
Patient satisfaction
Radiosurgery
Recurrence
Retrospective Studies
Rhizotomy
Sensation Disorders
Treatment Outcome
Trigeminal Neuralgia - surgery
Abstract
Trigeminal neuralgia pain causes severe disability. Stereotactic radiosurgery is the least invasive surgical option for patients with trigeminal neuralgia. Since different medical and surgical options have different rates of pain relief and morbidity, it is important to evaluate longer-term outcomes.
The authors retrospectively reviewed outcomes in 503 medically refractory patients with trigeminal neuralgia who underwent Gamma Knife surgery (GKS). The median patient age was 72 years (range 26-95 years). Prior surgery had failed in 205 patients (43%). The GKS typically was performed using MR imaging guidance, a single 4-mm isocenter, and a maximum dose of 80 Gy.
Patients were evaluated for up to 16 years after GKS; 107 patients had > 5 years of follow-up. Eighty-nine percent of patients achieved initial pain relief that was adequate or better, with or without medications (Barrow Neurological Institute [BNI] Scores I-IIIb). Significant pain relief (BNI Scores I-IIIa) was achieved in 73% at 1 year, 65% at 2 years, and 41% at 5 years. Including Score IIIb (pain adequately controlled with medication), a BNI score of I-IIIb was found in 80% at 1 year, 71% at 3 years, 46% at 5 years, and 30% at 10 years. A faster initial pain response including adequate and some pain relief was seen in patients with trigeminal neuralgia without additional symptoms, patients without prior surgery, and patients with a pain duration of or = 3 prior failed surgical procedures. Fifty-three patients (10.5%) developed new or increased subjective facial paresthesias or numbness and 1 developed deafferentation pain; these symptoms resolved in 17 patients. Those who developed sensory loss had better long-term pain control (78% at 5 years).
Gamma Knife surgery proved to be safe and effective in the treatment of medically refractory trigeminal neuralgia and is of value for initial or recurrent pain management. Despite the goal of minimizing sensory loss with this procedure, some sensory loss may improve long-term outcomes. Pain relapse is amenable to additional GKS or another procedure.
Notes
Comment In: J Neurosurg. 2010 Apr;112(4):756-7; discussion 75719747049
PubMed ID
19747055 View in PubMed
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Gamma Knife surgery for trigeminal neuralgia: a review of 450 consecutive cases.

https://arctichealth.org/en/permalink/ahliterature138795
Source
J Neurosurg. 2010 Dec;113 Suppl:160-7
Publication Type
Article
Date
Dec-2010
Author
Jeroen B Verheul
Patrick E J Hanssens
Suan Te Lie
Sieger Leenstra
Hendrik Piersma
Guus N Beute
Author Affiliation
Gamma Knife Center Tilburg, Sint Elisabeth Hospital, Tilburg, The Netherlands. j.verheul@elisabeth.nl
Source
J Neurosurg. 2010 Dec;113 Suppl:160-7
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Pain Measurement
Proportional Hazards Models
Radiosurgery - instrumentation
Retrospective Studies
Treatment Outcome
Trigeminal Neuralgia - surgery
Abstract
The success rates and side effects of Gamma Knife surgery (GKS) in patients with trigeminal neuralgia (TN) are not fully clear. A comparison of data across previous reports is hampered by differences in treatment protocols, lengths of follow-up, and outcome criteria. The purpose of this paper is to contribute to knowledge of the efficacy of GKS in TN by reviewing data in a large group of patients with this disorder, who were treated with a uniform treatment protocol and evaluated using a well-established pain scale and Kaplan-Meier analysis.
The authors reviewed 450 treatments in 365 patents with medically refractory TN who were treated between June 2002 and October 2009 at the Gamma Knife Center Tilburg. In all patients 80 Gy was prescribed, with a single 4-mm isocenter located at the root entry zone (REZ). In 79 patients repeated GKS was performed using a uniform dose of 80 Gy, which was delivered, in a highly standardized manner, to a spot anterior to the position of the first treatment. Follow-up was obtained by reviewing the patients' medical records and conducting telephone interviews. Outcome was assessed using the Barrow Neurological Institute (BNI) pain scale and the BNI facial numbness scale.
The median follow-up period was 28 months. In the idiopathic TN group, rates of adequate pain relief, defined as BNI Pain Scores I-IIIB, were 75%, 60%, and 58% at 1, 3, and 5 years, respectively. In the multiple sclerosis (MS)-related TN group the rates of adequate pain relief were 56%, 30%, and 20% at 1, 3, and 5 years, respectively. Repeated GKS was as successful as the first. An analysis of our treatment strategy of repeated GKS showed rates of adequate pain relief of 75% at 5 years in the idiopathic TN and 46% in the MS-related TN group. Somewhat bothersome numbness was reported by 6% of patients after the first treatment and by 24% after repeated GKS. Very bothersome numbness was reported in 0.5% after the first GKS and in 2% after the second treatment.
In this study the authors analyzed outcomes of GKS in a large cohort of patients with TN; uniform treatment consisted of 80 Gy delivered to the REZ. The initial and long-term outcomes of pain relief and sensory dysfunction are comparable to recently published results at other institutions, where similar outcome criteria were used. These data should prove helpful to assist patients and clinicians in their TN management decisions.
PubMed ID
21121797 View in PubMed
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Glycerol rhizotomy versus gamma knife radiosurgery for the treatment of trigeminal neuralgia: an analysis of patients treated at one institution.

https://arctichealth.org/en/permalink/ahliterature173260
Source
Int J Radiat Oncol Biol Phys. 2005 Sep 1;63(1):82-90
Publication Type
Article
Date
Sep-1-2005
Author
Clarissa Febles Henson
H Warren Goldman
Robert H Rosenwasser
M Beverly Downes
Greg Bednarz
Edward C Pequignot
Maria Werner-Wasik
Walter J Curran
David W Andrews
Author Affiliation
Department of Radiation Oncology, Cooper University Medical Center, Camden, NJ, USA.
Source
Int J Radiat Oncol Biol Phys. 2005 Sep 1;63(1):82-90
Date
Sep-1-2005
Language
English
Publication Type
Article
Keywords
Aged
Female
Glycerol - therapeutic use
Humans
Male
Pain Measurement
Questionnaires
Radiosurgery
Recurrence
Rhizotomy - methods
Statistics as Topic
Time Factors
Treatment Outcome
Trigeminal Neuralgia - surgery
Abstract
Medically refractory trigeminal neuralgia (TN) has been treated with a variety of minimally invasive techniques, all of which have been compared with microvascular decompression. For patients not considered good surgical candidates, percutaneous retrogasserian glycerol rhizotomy (GR) and gamma knife (GK) radiosurgery are two minimally invasive techniques in common practice worldwide and used routinely at Jefferson Hospital for Neuroscience. Using a common pain scale outcomes questionnaire, we sought to analyze efficacies and morbidities of both treatments.
Between June 1994 and December 2002, 79 patients were treated with GR and 109 patients underwent GK for the treatment of TN. GR was performed with fluoroscopic guidance as an overnight inpatient procedure. GK was performed using a single 4-mm shot positioned at the root exit zone of the trigeminal nerve. Radiation doses of 70-90 Gy prescribed to the 100% isodose line were used. Treatment outcomes including pain response, pain recurrence, treatment failure, treatment-related side effects, and overall patient satisfaction with GK and GR were compared using a common outcomes scale. Using the Barrow Neurologic Institute pain scale, patients were asked to define their level of pain both before and after treatment: I, no pain and no pain medication required; I, occasional pain not requiring medication; IIIa, no pain and pain medication used; IIIb, some pain adequately controlled with medication; IV, some pain not adequately controlled with medication; and V, severe pain with no relief with medication. We used posttreatment scores of I, II, IIIa, and IIIb to identify treatment success, whereas scores of IV and V were considered treatment failure. Results were compiled from respondents and analyzed using SAS software. Statistical comparisons used log-rank test, univariate and multivariate logistic regression, Fisher's exact test, and Wilcoxon test with significance established at p
PubMed ID
16111575 View in PubMed
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30 records – page 1 of 3.