Gamma Knife surgery for recurrent or residual trigeminal neuralgia after a failed initial procedure

doi:10.3171/2010.8.GKS10915

中山醫學大學機構典藏 CSMUIR > 醫學院 > 醫學系 > 期刊論文 > Item 310902500/3841

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题名:	Gamma Knife surgery for recurrent or residual trigeminal neuralgia after a failed initial procedure
作者:	Chuan-Fu Huang;Shyh-Ying Chiou;Ming-Fang Wu;Hsien-Tang Tu;Wen-Shan Liu
贡献者:	中山醫學大學：醫學系
关键词:	trigeminal neuralgia;Gamma Knife surgery;radiosurgery;microvascular decompression
日期:	2010
上传时间:	2011-06-14T03:56:44Z (UTC)
摘要:	OBJECT: The purpose of this study was to assess outcomes of Gamma Knife surgery (GKS) as a second treatment for recurrent or residual trigeminal neuralgia (TN) after failure of 3 initial procedures: microvascular decompression (MVD), GKS, and percutaneous radiofrequency rhizotomy (PRR). METHODS: Between 1999 and 2008, 65 patients (31 men [48%] and 34 women [52%]) with recurrent TN were treated with GKS. All 65 patients had undergone previous medical procedures that failed to achieve sufficient pain relief: 27 patients (42%) had undergone MVD, 8 (12%) had undergone PRR, and 30 (46%) had undergone GKS as the initial treatment. The entry zone of the trigeminal nerve was targeted using a 4-mm collimator and treated with 35-90 Gy. The isocenter was positioned so that the brainstem surface was usually irradiated at an isodose no greater than 20% (59 patients) to 30% (6 patients). The median duration of TN symptoms in these patients was 39 months (range 1-192 months). RESULTS: At the clinical evaluation, 42 patients (65%) with idiopathic TN reported successful pain control at a median follow-up point of 64 months (range 18-132 months). Of these patients, 33 (51%) were no longer using medication. At the 1-, 2-, and 3-year follow-up examinations, 74%, 71%, and 66% of patients experienced successful pain control, respectively. There was no significant difference in pain relief in the initial MVD group compared with the initial GKS and initial PRR groups (74% vs 59% and 50%, respectively; p = 0.342). Recurrence of pain was noted in 23 patients. Twelve of these 23 patients underwent another GKS, resulting in pain control in 8 patients (67%); 8 other patients underwent MVD, resulting in pain relief in 7 patients (87.5%). The median time from GKS to pain recurrence was 7 months (range 3-48 months). There was no significant difference in new facial numbness among the 3 groups (p = 0.24); however, in the initial GKS group, facial numbness was significantly associated with freedom from pain (p = 0.0012). There was a significant correlation between the total radiation dose and facial numbness. The cutoff value for facial numbness ranged from 115 to 120 Gy (p = 0.037). CONCLUSIONS: Gamma Knife surgery as a second treatment achieved acceptable levels of pain control in 65% of patients with residual or recurrent TN after long-term follow-up. Initial treatment was not a factor that affected pain control, but salvage surgery may be considered separately for each group.
URI:	https://ir.csmu.edu.tw:8080/ir/handle/310902500/3841 http://dx.doi.org/10.3171/2010.8.GKS10915
關聯:	J Neurosurg. 2010 Dec;113 Suppl:172-7.
显示于类别:	[醫學系] 期刊論文

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