Artikel
Repeated gamma knife radiosurgery for medically intractable trigeminal neuralgia
Funktionelle Radiochirurgie: die zweifache Behandlung bei therapieresistenter Trigeminusneuralgie
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Autoren
Veröffentlicht: | 23. April 2004 |
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Gliederung
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Objective
Gamma Knife radiosurgery (GKS) is being increasingly performed in the management of patients with medically unresponsive trigeminal neuralgia. It is the least invasive surgical option for patients, particularly for elderly ones with medical problems. The study evaluates the results of repeated GKS in patients with resistant/recurrent facial pain after their initial procedure.
Methods
In our series at the University of Graz, a total of 15 patients (9 male: 6 female, aged between 56-79 years, median 68 years) with idiopathic trigeminal neuralgia underwent repeated GKS. GKS had provided no significant pain relief or recurrent facial pain was observed. Treatment with a single 4-mm isocentre of radiation with a dose of 70-85 Gy was performed 4-24 months (median 7 months) after primary GKS. Radiosurgical target was the proximal trigeminal nerve root as it exited the brainstem. A median follow-up of 30 months (range: 20-96 months) was documented clinically and with MR images.
Results
Eight patients (53%) became pain-free and required no medication. 3 patients (20%) had a significant pain reduction of 50-90%. 4 patients (27%) reported no, or only fair improvement and/or recurrence of pain. Six patients developed facial numbness or paresthesias.
Conclusions
Repeated GKS is associated with a high rate of pain relief for patients with trigeminal neuralgia, who had insufficient improvement after the primary procedure. However, patients developed in a higher rate some degree of trigeminal dysfunction.