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55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

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Repeated gamma knife radiosurgery for medically intractable trigeminal neuralgia

Funktionelle Radiochirurgie: die zweifache Behandlung bei therapieresistenter Trigeminusneuralgie

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  • corresponding author Frank Unger - Universitätsklinik für Neurochirurgie, Medizinische Universität, Graz /A
  • G. Papaefthymiou - Universitätsklinik für Neurochirurgie, Medizinische Universität, Graz /A
  • H. Guss - Universitätsklinik für Strahlentherapie-Radioonkologie, Medizinische Universität, Graz /A
  • O. Schröttner - Universitätsklinik für Neurochirurgie, Medizinische Universität, Graz /A

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocP 11.117

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2004/04dgnc0400.shtml

Published: April 23, 2004

© 2004 Unger et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

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.