Article
Radiosurgery for the treatment of trigeminal neuralgia
Radiochirurgie zur Behandlung der Trigeminusneuralgie
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Authors
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Götz Lütjens
- Gamma Knife Zentrum Krefeld, Hannover, Deutschland
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Albertus T.C.J. van Eck
- Gamma Knife Zentrum Krefeld, Hannover, Deutschland
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Otto Bundschuh
- Gamma Knife Zentrum Krefeld, Hannover, Deutschland
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Gerhard Horstmann
- Gamma Knife Zentrum Krefeld, Hannover, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: Medically refractory trigeminal neuralgia can be treated by microvascular decompression of the trigeminal nerve, by ablative percutaneous treatments such as thermocoagulation, glycerol/alcohol injection and balloon compression of the Gasserian ganglion or, far less invasive, by radiosurgery that has been proven to elegantly and highly effectively treat this pain condition. We here report about the results at our institution.
Methods: We evaluated our outcomes retrospectively in our patients with medically refractory trigeminal neuralgia treated with radiosurgery. One 4mm shot was placed along the trigeminal nerve (either retrogasserian, mid-cisternal or at the root entry zone) as the chosen target. Pain scores and side effects were documented regularly.
Results: 232 patients treated between the years 1999-2019 were included into this study. 15 patients received repeated gamma Knife radiosurgery. The average age was 65 years. 58 patients had prior therapies other than medication. Mean follow up was 406 days. Multiple sclerosis as a comorbidity was present in 38 patients. Pain condition last in average 10 years till radiosurgery was performed. The average maximum dose was 89 Gy.The 10 Gy volume of the brain stem in average was 0,12ccm. Radiosurgery was successful in 78% as defined by the Barrow neurological institute pain score (BNI) I-III and failed in 22% of the patients. Hypesthesia was seen in 12%. Pain quality changed to ongoing pain in 4 patients. No life threatening events occurred.
Conclusion: Radiosurgery is proven to be an effective and safe treatment option for trigeminal neuralgia and long-term results are available. In our patients side effects were rare and less present then generally cited in the literature and its risk profile is lower compared to any other treatment. Given the fact of absent invasiveness radiosurgery should be considered in the first place in patients with (high risk) comorbidities, elderly patients and patients with prior surgically treatments and refractory/relapse pain condition.
