Early Stereotactic Radiosurgery for Medically Refractory Trigeminal Neuralgia.

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Early Stereotactic Radiosurgery for Medically Refractory Trigeminal Neuralgia.

World Neurosurg. 2018 Jan 22;:

Authors: Lee CC, Chen CJ, Chong ST, Hung SC, Yang HC, Lin CJ, Wu CC, Chung WY, Guo WY, Pan DH, Wu HM, Lin CP

Abstract
OBJECTIVE: To evaluate the effectiveness of early GKRS in the treatment of medically refractory trigeminal neuralgia (TN).
METHODS: This retrospective review covers 108 consecutive patients presenting with medically refractory, idiopathic TN between 2006 and 2014. All patients underwent gamma knife radiosurgery (GKRS) treatment targeting the root entry zone (REZ) with median maximum dose of 90 Gy and isodose line of 20%. Outcomes pertaining to pain and facial numbness were scored using the Barrow Neurological Institute (BNI) pain and facial numbness scales, respectively.
RESULTS: Following a median latency period of four weeks, we observed complete or adequate pain relief (BNI scores of I to IIIB) in 86 of the 108 patients (90%). Twenty-two patients (26%) experienced pain recurrence at a median period of 17 months. Fifty-nine patients (55%) reported new onset facial numbness. The treatment failure rates were highest among patients with a longer history of pain. Compared to patients with pain history of ≤5 years, those with pain history of >5 years experienced longer latency prior to pain relief (p=0.027). Univariate and multivariate analyses demonstrated that pain history of ≤5 years was a significant predictor of pain relief (p=0.049 and p=0.045, respectively).
CONCLUSIONS: GKRS achieves a high rate of pain relief among patients with medically refractory, idiopathic TN. Pain history of ≤5 years is a reliable predictor of pain relief and appears to be associated with shorter latency to pain relief following GKRS. This means that early GKRS treatment for patients with medically refractory idiopathic TN is recommended.

PMID: 29371169 [PubMed - as supplied by publisher]

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