Artikel
Recurrent trigeminal neuralgia: long-term outcome of repeat gamma knife radiosurgery
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Autoren
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F. Unger
- Universitätsklinik für Neurochirurgie, Medizinische Universität Graz
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V. Gellner
- Universitätsklinik für Neurochirurgie, Medizinische Universität Graz
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P. Ofner-Kopeinig
- Institut für Medizinische Informatik, Statistik und Dokumentation, Medizinische Universität Graz
| Veröffentlicht: | 20. Mai 2009 |
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Gliederung
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Objective: To date, efficacy and safety of repeat radiosurgery (RS) for trigeminal neuralgia (TN) are mainly inferred from short-term results.
Methods: Between 1994 and 2006, 93 patients were treated radiosurgically for TN at our department. Twenty-two patients underwent repeat GKRS at a mean of 18.8 months after the initial treatment. The mean dose for repeat treatment was 74.3Gy. Pain outcome was rated using the Barrow Neurological Institute (BNI) Pain Intensity Scale, and facial numbness graded according to the BNI Facial Numbness Scale.
Results: Mean follow-up after repeat RS was 5.4 years. Pain relief was noted in 72.7% (16/22), 6 patients had a second pain recurrence after a mean of 9.3 months and underwent medical, alternative and/or further RS. One patient was lost to follow-up, BNI pain scale evaluation for 21 patients indicated improvement in 76.2% (16/21) without medication (BNI I and II). Facial numbness was recorded in 73.7% (14/19), in only one case classified as bothersome.
Conclusions: Long-term observation of repeat GKRS for TN showed good pain relief in more than two thirds of patients. Despite a high percentage of facial numbness - most likely attributable to the higher delivered dose - repeat RS can still be regarded as safe. However, further studies are needed to determine an optimized treatment protocol.
