Outcomes following single-treatment Gamma Knife surgery for trigeminal neuralgia with a minimum 3-year follow-up

Ron I. Riesenburger, Steven W. Hwang, Clemens M. Schirmer, Vasilios Zerris, Julian K. Wu, Kerry Mahn, Paul Klimo, John Mignano, Clinton J. Thompson, Kevin C. Yao

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Abstract

Object. Gamma Knife surgery (GKS) has been shown to be effective in treating trigeminal neuralgia (TN). Existing studies have demonstrated success rates of 69.1-85% with median follow-up intervals of 19-60 months. However, series with uniform long-term follow-up data for all patients have been lacking. In the present study the authors examined outcomes in a series of patients with TN who underwent a single GKS treatment followed by a minimum follow-up of 36 months. They used a clinical scale that simplifies the reporting of outcome data for patients with TN. Methods. Fifty-three consecutive patients with typical, intractable TN received a median maximum radiation dose of 80 Gy applied with a single 4-mm isocenter to the affected trigeminal nerve. Follow-up data were obtained by clinical examination and questionnaire. Outcome results were categorized into the following classes (in order of decreasing success): Class 1A, complete pain relief without medications; 1B, complete pain relief with either a decrease or no change in medications; 1C, = 50% pain relief without medications; 1D, = 50% pain relief with either a decrease or no change in medications; and Class 2, < 50% pain relief and/or increase in medications. Patients with Class 1A-1D outcome (equivalent to Barrow Neurological Institute Grades I-IIIb) were considered to have a good treatment outcome, whereas in patients with Class 2 outcome (equivalent to Barrow Neurological Institute Grades IV and V) treatment was considered to have failed. Results. A good treatment outcome from initial GKS was achieved in 31 (58.5%) patients for whom the mean follow-up period was 48 months (range 36-66 months). Outcomes at last follow-up were reflected by class status: Class 1A, 32.1% of patients; 1B, 1.9%; 1C, 3.8%; 1D, 20.8%; and Class 2, 41.5%. Statistical analysis showed no difference in outcomes between patients previously treated with microvascular decompression or rhizotomy compared with patients with no previous surgical treatments. Thirty-six percent of patients reported some degree of posttreatment facial numbness. Anesthesia dolorosa did not develop in any patient. Conclusions. Despite a time-dependent deterioration in the success rate of GKS for medically intractable TN, the authors' study showed that > 50% of patients can be expected to have a good outcome based on their scoring system, with ∼ 33% having an ideal outcome (pain free with no need for medications). Long-term data, as those presented here, are important when counseling patients on their treatment options.

Original languageEnglish (US)
Pages (from-to)766-771
Number of pages6
JournalJournal of neurosurgery
Volume112
Issue number4
DOIs
StatePublished - Apr 1 2010

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Trigeminal Neuralgia
Pain
Therapeutics
Trigeminal Nerve
Counseling
Research Design
Radiation

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Riesenburger, R. I., Hwang, S. W., Schirmer, C. M., Zerris, V., Wu, J. K., Mahn, K., ... Yao, K. C. (2010). Outcomes following single-treatment Gamma Knife surgery for trigeminal neuralgia with a minimum 3-year follow-up. Journal of neurosurgery, 112(4), 766-771. https://doi.org/10.3171/2009.8.JNS081706

Outcomes following single-treatment Gamma Knife surgery for trigeminal neuralgia with a minimum 3-year follow-up. / Riesenburger, Ron I.; Hwang, Steven W.; Schirmer, Clemens M.; Zerris, Vasilios; Wu, Julian K.; Mahn, Kerry; Klimo, Paul; Mignano, John; Thompson, Clinton J.; Yao, Kevin C.

In: Journal of neurosurgery, Vol. 112, No. 4, 01.04.2010, p. 766-771.

Research output: Contribution to journalArticle

Riesenburger, RI, Hwang, SW, Schirmer, CM, Zerris, V, Wu, JK, Mahn, K, Klimo, P, Mignano, J, Thompson, CJ & Yao, KC 2010, 'Outcomes following single-treatment Gamma Knife surgery for trigeminal neuralgia with a minimum 3-year follow-up', Journal of neurosurgery, vol. 112, no. 4, pp. 766-771. https://doi.org/10.3171/2009.8.JNS081706
Riesenburger, Ron I. ; Hwang, Steven W. ; Schirmer, Clemens M. ; Zerris, Vasilios ; Wu, Julian K. ; Mahn, Kerry ; Klimo, Paul ; Mignano, John ; Thompson, Clinton J. ; Yao, Kevin C. / Outcomes following single-treatment Gamma Knife surgery for trigeminal neuralgia with a minimum 3-year follow-up. In: Journal of neurosurgery. 2010 ; Vol. 112, No. 4. pp. 766-771.
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abstract = "Object. Gamma Knife surgery (GKS) has been shown to be effective in treating trigeminal neuralgia (TN). Existing studies have demonstrated success rates of 69.1-85{\%} with median follow-up intervals of 19-60 months. However, series with uniform long-term follow-up data for all patients have been lacking. In the present study the authors examined outcomes in a series of patients with TN who underwent a single GKS treatment followed by a minimum follow-up of 36 months. They used a clinical scale that simplifies the reporting of outcome data for patients with TN. Methods. Fifty-three consecutive patients with typical, intractable TN received a median maximum radiation dose of 80 Gy applied with a single 4-mm isocenter to the affected trigeminal nerve. Follow-up data were obtained by clinical examination and questionnaire. Outcome results were categorized into the following classes (in order of decreasing success): Class 1A, complete pain relief without medications; 1B, complete pain relief with either a decrease or no change in medications; 1C, = 50{\%} pain relief without medications; 1D, = 50{\%} pain relief with either a decrease or no change in medications; and Class 2, < 50{\%} pain relief and/or increase in medications. Patients with Class 1A-1D outcome (equivalent to Barrow Neurological Institute Grades I-IIIb) were considered to have a good treatment outcome, whereas in patients with Class 2 outcome (equivalent to Barrow Neurological Institute Grades IV and V) treatment was considered to have failed. Results. A good treatment outcome from initial GKS was achieved in 31 (58.5{\%}) patients for whom the mean follow-up period was 48 months (range 36-66 months). Outcomes at last follow-up were reflected by class status: Class 1A, 32.1{\%} of patients; 1B, 1.9{\%}; 1C, 3.8{\%}; 1D, 20.8{\%}; and Class 2, 41.5{\%}. Statistical analysis showed no difference in outcomes between patients previously treated with microvascular decompression or rhizotomy compared with patients with no previous surgical treatments. Thirty-six percent of patients reported some degree of posttreatment facial numbness. Anesthesia dolorosa did not develop in any patient. Conclusions. Despite a time-dependent deterioration in the success rate of GKS for medically intractable TN, the authors' study showed that > 50{\%} of patients can be expected to have a good outcome based on their scoring system, with ∼ 33{\%} having an ideal outcome (pain free with no need for medications). Long-term data, as those presented here, are important when counseling patients on their treatment options.",
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AU - Riesenburger, Ron I.

AU - Hwang, Steven W.

AU - Schirmer, Clemens M.

AU - Zerris, Vasilios

AU - Wu, Julian K.

AU - Mahn, Kerry

AU - Klimo, Paul

AU - Mignano, John

AU - Thompson, Clinton J.

AU - Yao, Kevin C.

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N2 - Object. Gamma Knife surgery (GKS) has been shown to be effective in treating trigeminal neuralgia (TN). Existing studies have demonstrated success rates of 69.1-85% with median follow-up intervals of 19-60 months. However, series with uniform long-term follow-up data for all patients have been lacking. In the present study the authors examined outcomes in a series of patients with TN who underwent a single GKS treatment followed by a minimum follow-up of 36 months. They used a clinical scale that simplifies the reporting of outcome data for patients with TN. Methods. Fifty-three consecutive patients with typical, intractable TN received a median maximum radiation dose of 80 Gy applied with a single 4-mm isocenter to the affected trigeminal nerve. Follow-up data were obtained by clinical examination and questionnaire. Outcome results were categorized into the following classes (in order of decreasing success): Class 1A, complete pain relief without medications; 1B, complete pain relief with either a decrease or no change in medications; 1C, = 50% pain relief without medications; 1D, = 50% pain relief with either a decrease or no change in medications; and Class 2, < 50% pain relief and/or increase in medications. Patients with Class 1A-1D outcome (equivalent to Barrow Neurological Institute Grades I-IIIb) were considered to have a good treatment outcome, whereas in patients with Class 2 outcome (equivalent to Barrow Neurological Institute Grades IV and V) treatment was considered to have failed. Results. A good treatment outcome from initial GKS was achieved in 31 (58.5%) patients for whom the mean follow-up period was 48 months (range 36-66 months). Outcomes at last follow-up were reflected by class status: Class 1A, 32.1% of patients; 1B, 1.9%; 1C, 3.8%; 1D, 20.8%; and Class 2, 41.5%. Statistical analysis showed no difference in outcomes between patients previously treated with microvascular decompression or rhizotomy compared with patients with no previous surgical treatments. Thirty-six percent of patients reported some degree of posttreatment facial numbness. Anesthesia dolorosa did not develop in any patient. Conclusions. Despite a time-dependent deterioration in the success rate of GKS for medically intractable TN, the authors' study showed that > 50% of patients can be expected to have a good outcome based on their scoring system, with ∼ 33% having an ideal outcome (pain free with no need for medications). Long-term data, as those presented here, are important when counseling patients on their treatment options.

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