Long-Term Outcome of Gamma Knife Radiosurgery for Treatment of Typical Trigeminal Neuralgia

• Published in: International journal of radiation oncology, biology, physics Vol. 75; no. 3; pp. 822 - 827
• Main Authors: Han, Jung Ho, M.D, Kim, Dong Gyu, M.D., Ph.D, Chung, Hyun-Tai, Ph.D, Paek, Sun Ha, M.D., Ph.D, Kim, Yong Hwy, M.D, Kim, Chae-Yong, M.D., Ph.D, Kim, Jin Wook, M.D, Kim, Young-Hoon, M.D, Jeong, Sang Soon, R.N
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2009
• Subjects: Adult; Aged; Aged, 80 and over; Analysis of Variance; BODY; Disease-Free Survival; FACE; Female; Follow-Up Studies; Gamma knife; HEAD; Hematology, Oncology and Palliative Medicine; Humans; Long-term outcome; Male; MEDICINE; Middle Aged; NUCLEAR MEDICINE; PAIN; Pain Measurement; RADIOLOGY; RADIOLOGY AND NUCLEAR MEDICINE; Radiosurgery; RADIOTHERAPY; Radiotherapy Dosage; Recurrence; SURGERY; SYMPTOMS; THERAPY; Treatment Outcome; Trigeminal neuralgia; Trigeminal Neuralgia - surgery; Trigeminal neuralgia; Long-term outcome; Radiosurgery; Gamma knife
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2008.11.046

Purpose To analyze the long-term outcomes of patients with typical trigeminal neuralgia treated with gamma knife radiosurgery (GKRS). Patients and Methods A total of 62 consecutive patients with typical trigeminal neuralgia were treated with GKRS between 1998 and 2004. Of the 62 patients, 2 were lost to follow-up; the remaining 60 patients were followed for >12 months. The mean prescribed maximal dose was 79.7 Gy (range, 75–80), using a 4-mm shot. Results Of the 60 patients, 48 were followed for >4 years. An additional 3 patients, followed for <4 years, experienced recurrent pain after a favorable initial response and were incorporated into the long-term response analysis. Of these 51 patients (mean age, 61 ± 11 years; 37 women [72.5%]; and mean follow-up duration, 58 ± 14 months), 46 (90.2%) responded to GKRS, as demonstrated by an improvement in their Barrow Neurological Institute pain intensity score. Of the 46 patients, 24 (52.2%) had pain recurrence. The actuarial recurrence-free survival rate was 84.8%, 76.1%, 69.6%, 63.0%, and 45.8% at 1, 2, 3, 4, and 5 years after radiosurgery, respectively. Patient age >70 years correlated with a favorable outcome in terms of pain recurrence after radiosurgery (hazard ratio, 0.125; 95% confidence interval, 0.016–0.975; p = .047) on multivariate analysis. Conclusion GKRS seems to be an effective treatment modality for patients with typical trigeminal neuralgia considering the initial response rate; however, fewer than one-half of patients might continue to benefit from GKRS after long-term follow-up. Elderly patients might be good candidates for radiosurgery considering the long-term durability of efficacy.