gms | German Medical Science

73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

Pain-relief related structural cortical alterations in trigeminal neuralgia induced by Gamma Knife radiosurgery

Durch Schmerzreduktion über Gamma Knife Radiochirurgie hervorgerufene strukturelle kortikale Veränderungen bei Trigeminusneuralgie

Meeting Abstract

  • presenting/speaker Jonas Kolodziej - Ruhr-Universität Bochum, Bochum, Deutschland
  • Bogdan Pintea - BG UniversitätsklinikumBergmannsheil Bochum, Neurochirurgie, Bochum, Deutschland
  • Burkhard Pleger - BG UniversitätsklinikumBergmannsheil Bochum, Neurologie, Bochum, Deutschland; Ruhr-Universität Bochum, Collaborative Research Centre 874 “Integration and Representation of Sensory Processes”, Bochum, Deutschland
  • Jan Boström - MediClin Robert Janker Clinic and MediClin MVZ Bonn, Department of Radiosurgery and Stereotactic Radiotherapy, Bonn, Deutschland; Universitätsklinikum Marien Hospital Herne, Gamma Knife Zentrum Bochum, Department of Radiotherapy and Radio-Oncology, Bochum, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocP105

doi: 10.3205/22dgnc415, urn:nbn:de:0183-22dgnc4153

Veröffentlicht: 25. Mai 2022

© 2022 Kolodziej et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe



Objective: Recent studies on trigeminal neuralgia (TN) have shown that cortical changes, especially in the pain matrix, are common in TN patients, which leads to the question whether these alterations are reactive or contribute to the etiology. Although there are a several studies that have investigated structural brain plasticity in TN with MRI-based Voxel-based-Morphometry (VBM), only few have focused on the reversibility of these changes due to treatment. As Gamma Knife (GK) radiosurgery (RS) is an established therapeutic option in TN, it was our goal to examine its effects on cortical structures.

Methods: We acquired T1-MPRAGE MRI scans of 25 patients with TN (16 women; mean age 66.7 y) prior to and after GK RS. The Barrow Neurological Institute (BNI) score was applied as an index of therapy induced pain relief. Using the CAT12 toolbox in SPM12, MRI images were segmented to assess each individual’s grey matter segments, modulated using the DARTEL algorithm and finally smoothed. We conducted a regression analysis between the differences in gray matter segments (post minus pre GK RS) and the reduction in the BNI scores. A family-wise-corrected cluster level at p=0.05 indexed significance. Anatomic labeling of significant clusters was done with the anatomy toolbox in SPM12.

Results: Almost all patients (23/25) benefited from the GK RS (BNI score reductions from 0.12 +/- 0.33 to 2.32 +/- 1.02). Regression analysis showed a significant association between the reduction in BNI scores and a gain of gray matter density in the left dorsolateral prefrontal cortex (DLPFC) [p=0.001], the left lingual gyrus [p=0.017], the right precentral gyrus (PCG) [p=0.014], and the left cerebellum [p=0.000]. We found no significant BNI-related reductions in gray matter density.

Conclusion: GK RS in TN induces structural plasticity in several clusters: the DLPFC has long been implicated in executive control and the lingual gyrus promotes higher-order visual processing, whereas the PCG and the cerebellum are involved in motor control and execution. If a gain in gray matter density reflects gain in function, our findings suggest that GK RS induced pain-relief is associated with an improvement in executive, sensory and motor functioning, possibly because less distracting pain requires less top-down control. Since the obtained BNI-related brain plasticity occurred in the same brain regions as previously identified in TN patients, our findings further suggest that some of the cortical changes in TN might be reversible.