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72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

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Comparison of treatment efficacy and outcome in patients with refractory trigeminal neuralgia and neurological co-morbidity – CyberKnife radiosurgery vs. radiofrequency thermocoagulation

Vergleich der Effektivität und des Outcomes nach CyberKnife-Radiochirurgie oder Thermokoagulation in Patienten mit therapierefraktärer Trigeminusneuralgie und neurologischer Ko-Morbidität

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  • presenting/speaker Franziska Löbel - Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Carolin Senger - Charité Universitätsmedizin, Klinik für Radioonkologie, Berlin, Deutschland
  • Eduart Temaj - Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Anne Kathrin Kluge - Charité Universitätsmedizin, Klinik für Radioonkologie, Berlin, Deutschland
  • Güliz Acker - Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Ulf C. Schneider - Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Julia Onken - Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Wibke Klene - Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Melina Kord - Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Volker Budach - Charité Universitätsmedizin, Klinik für Radioonkologie, Berlin, Deutschland
  • Peter Vajkoczy - Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Nora Dengler - Charité Universitätsmedizin, Klinik für Neurochirurgie, Berlin, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocV083

doi: 10.3205/21dgnc083, urn:nbn:de:0183-21dgnc0832

Published: June 4, 2021

© 2021 Löbel et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Treatment of symptomatic trigeminal neuralgia (TN) in patients with neurological co-morbidites, e.g., multiple sclerosis remains challenging. Single-fraction Cyberknife radiosurgery (CK) and retrogasserian thermocoagulation (TC) are possible therapeutic options. We aimed to compare treatment efficacy and outcome in patients with TN treated by CK or TC with respect to neurological co-morbidities.

Methods: Clinical and radiographic data of patients with TN treated with single-fraction CK or TC at a single academic institution were analyzed. Pain level was evaluated using the Barrow Neurological Institute (BNI) pain scale pre-intervention and 3,6, 12 and 24 months post-interventionally. Group comparison and multivariate statistical analysis was performed using SPSS. Data is given as mean and range. Ethical approval was granted by local authorities (EA 1/289/19).

Results: 107 patients (nCK=54 and nTC=53) were treated with 158 treatments. Mean age of the cohort was 61.2 (31.7-98.1) years, male to female ratio was 38 to 69. 22 patients had multiple treatments. Left-sided pain was present in 51 patients, right-sided pain in 56 patients. 44 patients had involvement of one branch, 56 patients of two or more branches. 53 patients had neurological co-morbidities; 40 of them were diagnosed with multiple sclerosis (nMCK=17, nMTC=23). Mean BNI pre-intervention was 4.2 (range 3 to 5), mean BNI post-procedural was 3.0 (range 1-5). Pain was improved after 133, stable after 22 and worse after 3 treatments. Mean BNI improvement in the TC subcohort at 3-months-follow-up was significantly better than in the CK cohort (1.22 vs. 1.72; p=0.023). Exclusive analysis of the multiple sclerosis subgroup revealed no significant difference in mean BNI improvement between patients treated with CK or TC (1.63 vs. 1.56; p=0.071). Incidence of new-onset hypaesthesia remained relatively low after both procedures (16.4%; CK=1.8%, TK=26.4%).

Conclusion: Both therapies present valid strategies for pain improvement. BNI improvement was significantly better in patients treated with TC in the cohort. In patients with multiple sclerosis as neurological co-morbidity, there was no difference in pain improvement between the two treatment modalities.