Kosin Med J.  2019 Jun;34(1):30-37. 10.7180/kmj.2019.34.1.30.

Gamma Knife Radiosurgery in Recurrent Trigeminal Neuralgia after Other Procedures

• Lee JM
• Hur BI
• Choi CH

• KMID: 2451773
• DOI: http://doi.org/10.7180/kmj.2019.34.1.30

Abstract

OBJECTIVES
Trigeminal neuralgia (TN) is undurable paroxysmal pain in the distribution of the fifth cranial nerve. Invasive treatment modalities for TN include microvascular decompression (MVD) and percutaneous procedures, such as, radiofrequency rhizotomy (RFR). Gamma Knife radiosurgery (GKRS) is a considerable option for patients with pain recurrence after an initial procedure. This study was undertaken to analyze the effects of gamma knife radiosurgery in recurrent TN after other procedures.
METHODS
Eleven recurrent TN patients after other procedures underwent GKRS in our hospital from September 2004 to August 2016. Seven patients had previously undergone MVD alone, two underwent MVD with partial sensory rhizotomy (PSR), and two underwent RFR. Mean patient age was 60.5 years. We retrospectively analyzed patient's characteristics, clinical results, sites, and divisions of pain. Outcomes were evaluated using the Visual Analog Scales (VAS) score.
RESULTS
Right sides were more prevalent than left sides (7:4). The most common distribution of pain was V1 + V2 division (n = 5) following V2 + V3 (n = 3), V2 (n = 2), and V1 + V2 + V3 (n = 1) division. Median GKRS dose was 80 Gy and the mean interval between the prior treatment and GKRS was 74.45 months. The final outcomes of subsequent GKRS were satisfactory in most cases, and at 12 months postoperatively ten patients (90.0%) had a VAS score of ≤ 3.
CONCLUSIONS
In this study, the clinical result of GKRS was satisfactory. Invasive procedures, such as, MVD, RFR are initially effective in TN patients, but GKRS provides a safe and satisfactory treatment modality for those who recurred after prior invasive treatments.

Keyword

Gamma Knife radiosurgery; Recurrent trigeminal neuralgia; Visual Analog Scale score

MeSH Terms

Humans
Microvascular Decompression Surgery
Radiosurgery*
Recurrence
Retrospective Studies
Rhizotomy
Trigeminal Nerve
Trigeminal Neuralgia*
Visual Analog Scale

Figure

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  Fig. 1 Gamma Knife radiosurgery isodose distributions including the root entry zone (REZ) of the trigeminal nerve immediately adjacent to the pons.

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  Fig. 2 VAS scores at each follow-up session of the 11 patients that underwent secondary GKRS.

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  Fig. 3 Kaplan-Meier estimates of the probabilities of initial pain relief after GKRS (A) Pain relief (VAS score < 5), (B) Significant pain relief (a VAS score reduction of ≥ 5)

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