Gamma Knife Radiosurgery for Idiopathic Trigeminal Neuralgia; does the status of offending vessels influence on pain control or side effects?

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Gamma Knife Radiosurgery for Idiopathic Trigeminal Neuralgia; does the status of offending vessels influence on pain control or side effects?

World Neurosurg. 2017 May 19;:

Authors: Jung HH, Park CK, Jung NY, Kim M, Chang WS, Chang JW

Abstract
OBJECTIVE: To determine pain control and side effects after gamma knife radiosurgery (GKRS) for classical idiopathic trigeminal neuralgia (TN) with or without neurovascular compression (NVC).
METHODS: This study included 47 patients with type 1 idiopathic TN and Barrow Neurological Institute (BNI) pain class IV or V that were treated with GKRS, with maximal dose of 85 Gy targeting root entry zone, as a first-treatment modality between January 2005 and March 2015. A retrospective analysis was made of NVC status, pain control, side effects, recurrence, and cross-sectional area.
RESULTS: During the median 21.5 months follow-up (range, 3-119 months), 36 (76.6%) patients showed good outcomes (improved to below BNI class IIIa). Twenty two patients did not show NVC (group A) and 25 had NVC present (group B). Good outcomes were not different in two groups (group A: 19/22; group B: 17/25)(p = 0.138). The numbers of cases in BNI class I or II, and recurrences were not different (p = 0.532, 0.786, respectively). The mean areas were 8.64 ± 2.59 mm3 in non-deviated cases (n = 27) and 2.59 ± 1.68 mm3 in deviated (n = 10). Side effects were significantly more frequent in deviated cases (8/10; 80%) than in non-deviated (7/27; 25.9%) (p = 0.003).
CONCLUSION: NVC is not a predictive factor for pain control after GKRS for the treatment of idiopathic TN. Side effects may occur more frequently in patients with NVC at the target coordinate when a root entry zone is used, but the subjective symptoms are not always bothersome.

PMID: 28532912 [PubMed - as supplied by publisher]

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