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Neurosurgical Review
Published in: Neurosurgical Review 4/2011

01-10-2011 | Original Article

Stereotactic radiosurgery of essential trigeminal neuralgia using Leksell Gamma Knife model C with automatic positioning system

Technical nuances and evaluation of outcome in 130 patients with at least 2 years follow-up after treatment

Authors: Motohiro Hayashi, Mikhail Chernov, Noriko Tamura, Takaomi Taira, Masahiro Izawa, Shoji Yomo, Mariko Nagai, Cheng-Siu Chang, Pavel Ivanov, Manabu Tamura, Yoshihiro Muragaki, Yoshikazu Okada, Hiroshi Iseki, Kintomo Takakura

Published in: Neurosurgical Review | Issue 4/2011

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Abstract

The objective of the present study was the evaluation of outcome in 130 patients with essential trigeminal neuralgia, who were treated using Leksell Gamma Knife model C with automatic positioning system and followed at least 24 months thereafter. Radiosurgery was guided by fused thin-sliced magnetic resonance (MR) and “bone window” computed tomographic (CT) images. In all cases, retrogasserian part of the trigeminal nerve at the level of trigeminal incisura was selected as a target, and one 4-mm collimator was used for delivery of the maximum irradiation dose of 90 Gy. The coordinates of the isocenter were adjusted for positioning of the nerve in the center of 80% isodose area, and were corrected in each individual case with regard to presence of distortion artifacts on MR images. Initial relief of the typical paroxysmal facial pain was marked in 127 patients (98%) within a median interval of 3 weeks after treatment. However, in 23 patients the pain re-appeared later on. Overall, at the time of the last follow-up 112 patients (86%) were pain-free, including 86 who remained both pain- and medication-free after initial radiosurgery. In 31 cases (24%), treatment was complicated by facial hypesthesia and/or paresthesia. In conclusion, radiosurgery of essential trigeminal neuralgia results in a high rate of initial pain relief, but pain recurrences and associated complications are not uncommon. The outcome may be influenced by various technical nuances; therefore, treatment should be preferably done in specialized clinical centers with sufficient expertise in the management of this disorder.
Literature
1.
Aubuchon AC, Chan MD, Lovato JF, Balamucki CJ, Ellis TL, Tatter SB, McMullen KP, Munley MT, Deguzman AF, Ekstrand KE, Bourland JD, Shaw EG (2011) Repeat gamma knife radiosurgery for trigeminal neuralgia. Int J Radiat Oncol Biol Phys (in press)
2.
Azar M, Yahyavi ST, Bitaraf MA, Gazik FK, Allahverdi M, Shahbazi S, Alikhani M (2009) Gamma knife radiosurgery in patients with trigeminal neuralgia: quality of life, outcomes, and complications. Clin Neurol Neurosurg 111:174–178PubMedCrossRef
3.
Dellaretti M, Reyns N, Touzet G, Sarrazin T, Dubois F, Lartigau E, Blond S (2008) Clinical outcomes after gamma knife surgery for idiopathic trigeminal neuralgia: review of 76 consecutive cases. J Neurosurg 109:173–178PubMedCrossRef
4.
Dhople AA, Adams JR, Maggio WW, Naqvi SA, Regine WF, Kwok Y (2009) Long-term outcomes of gamma knife radiosurgery for classic trigeminal neuralgia: implications of treatment and critical review of the literature. J Neurosurg 111:351–358PubMedCrossRef
5.
Dvorak T, Finn A, Price LL, Mignano JE, Fitzek MM, Wu JK, Yao KC (2009) Retreatment of trigeminal neuralgia with gamma knife radiosurgery: is there an appropriate cumulative dose? J Neurosurg 111:359–364PubMedCrossRef
6.
Flickinger JC, Pollock BE, Kondziolka D, Phuong LK, Foote RL, Stafford SL, Lunsford LD (2001) Does increased nerve length within the treatment volume improve trigeminal neuralgia radiosurgery? A prospective double-blind, randomized study. Int J Radiat Oncol Biol Phys 51:449–454PubMedCrossRef
7.
Fountas KN, Smith JR, Lee GP, Jenkins PD, Cantrell RR, Sheils WC (2007) Gamma knife stereotactic radiosurgical treatment of idiopathic trigeminal neuralgia: long-term outcome and complications. Neurosurg Focus 23(6):E8PubMedCrossRef
8.
Fukuoka S (2004) Japan multi-institutional study of trigeminal neuralgia treated with gamma knife. In: Program and Abstracts of the 12th international meeting of the Leksell gamma knife society, Vienna, Austria, 17–20 May 2004, p 121
9.
Gorgulho AA, De Salles AAF (2006) Impact of radiosurgery on the surgical treatment of trigeminal neuralgia. Surg Neurol 66:350–356PubMedCrossRef
10.
Han JH, Kim DG, Chung HT, Paek SH, Kim YH, Kim CY, Kim JW, Kim YH, Jeong SS (2009) Long-term outcome of gamma knife radiosurgery for treatment of typical trigeminal neuralgia. Int J Radiat Oncol Biol Phys 75:822–827PubMedCrossRef
11.
Hayashi M (2004) Current strategy of gamma knife surgery for intractable pain. No To Shinkei 56:458–473 (article in Japanese)PubMed
12.
Hayashi M, Ochiai T, Chernov M, Nakaya K, Izawa M, Hori T, Takakura K (2005) Gamma knife surgery for essential trigeminal neuralgia: new treatment strategy with robotized micro-radiosurgery. In: Meglio M (ed) 14th Meeting of the World Society for Stereotactic and Functional Neurosurgery (WSSFN), Rome (Italy), June 14–17, 2005. Medimond International Proceedings, Bologna, pp 231–238
13.
Hayashi M, Ochiai T, Murata N, Nakaya K, Izawa M, Chernov M, Hori T, Regis J, Takakura K (2006) Gamma knife surgery for essential trigeminal neuralgia: advantages in new treatment strategy with robotized micro-radiosurgery. In: Kondziolka D (ed) Radiosurgery, vol 6. Karger, Basel, pp 260–267CrossRef
14.
Hayashi M, Ochiai T, Nakaya K, Chernov M, Tamura N, Yomo S, Koyama N, Katayama Y, Kawakami Y, Taira T, Izawa M, Hori T, Takakura K (2006) Latest strategy of gamma knife surgery for essential trigeminal neuralgia: robotized micro-radiosurgery based on the evaluation and analysis of 220 patients experience. Funct Neurosurg 45:153–158
15.
Hayashi M, Tamura N, Hori T (2008) Gamma knife surgery for essential trigeminal neuralgia. No Shnikei Geka 36:961–976 (article in Japanese)
16.
Hayashi M (2009) Trigeminal neuralgia. In: Yamamoto M (ed) Japanese experience with gamma knife radiosurgery. Prog Neurol Surg, vol. 22. Karger, Basel, pp 182–190
17.
Hayashi M (2010) Gamma knife radiosurgery for intractable pain. In: Kida Y (ed) Functional aspects of radiosurgery. Neuron, Tokyo, pp 45–63
18.
Huang CF, Tu HT, Liu WS, Chiou SY, Lin LY (2008) Gamma knife surgery used as primary and repeated treatment for idiopathic trigeminal neuralgia. J Neurosurg 109:179–184PubMed
19.
Huang CF, Shiou SY, Wu MF, Tu HT, Liu WS (2010) Gamma knife surgery for recurrent or residual trigeminal neuralgia after a failed initial procedure. J Neurosurg 113(Suppl):172–177PubMed
20.
Jursinic PA, Rickert K, Gennarelli TA, Schultz CJ (2005) Effect of image uncertainty on the dosimetry of trigeminal neuralgia irradiation. Int J Radiat Oncol Biol Phys 62:1559–1567PubMedCrossRef
21.
Kano H, Kondziolka D, Yang HC, Zorro O, Lobato-Polo J, Flannery TJ, Flickinger JC, Lunsford LD (2010) Outcome predictors after gamma knife radiosurgery for recurrent trigeminal neuralgia. Neurosurgery 67:1637–1645PubMedCrossRef
22.
Kimball BY, Sorenson JM, Cunningham D (2010) Repeat gamma knife surgery for trigeminal neuralgia: long-term results. J Neurosurg 113(Suppl):178–183PubMed
23.
Kondziolka D, Zorro O, Lobato-Polo J, Kano H, Flannery TJ, Flickinger JC, Lunsford LD (2010) Gamma knife stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 112:758–765PubMedCrossRef
24.
Linskey ME, Ratanatharathorn V, Penagaricano J (2008) A prospective cohort study of microvascular decompression and gamma knife surgery in patients with trigeminal neuralgia. J Neurosurg 109(Suppl):160–172PubMed
25.
Little AS, Shetter AG, Shetter ME, Bay C, Rogers CL (2008) Long-term pain response and quality of life in patients with typical trigeminal neuralgia treated with gamma knife stereotactic radiosurgery. Neurosurgery 63:915–924PubMedCrossRef
26.
Little AS, Shetter AG, Shetter ME, Kakarla UK, Rogers CL (2009) Salvage gamma knife stereotactic radiosurgery for surgically refractory trigeminal neuralgia. Int J Radiat Oncol Biol Phys 74:522–527PubMedCrossRef
27.
Lopez BC, Hamlyn PJ, Zakrzewska JM (2004) Systematic review of ablative neurosurgical techniques for the treatment of trigeminal neuralgia. Neurosurgery 54:973–983PubMedCrossRef
28.
Maesawa S, Salame C, Flickinger JC, Pirris S, Kondziolka D, Lunsford LD (2001) Clinical outcomes after stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 94:14–20PubMedCrossRef
29.
Massager N, Lorenzoni J, Devriendt D, Desmedt F, Brotchi J, Levivier M (2004) Gamma knife surgery for idiopathic trigeminal neuralgia performed using a far-anterior cisternal target and a high dose of radiation. J Neurosurg 100:597–605PubMedCrossRef
30.
Massager N, Abeloos L, Devriendt D, Op de Beeck M, Levivier M (2007) Clinical evaluation of targeting accuracy of gamma knife radiosurgery in trigeminal neuralgia. Int J Radiat Oncol Biol Phys 69:1514–1520PubMedCrossRef
31.
Massager N, Murata N, Tamura M, Devriendt D, Levivier M, Regis J (2007) Influence of nerve radiation dose in the incidence of trigeminal dysfunction after trigeminal neuralgia radiosurgery. Neurosurgery 60:681–688PubMedCrossRef
32.
Matsuda S, Serizawa T, Nagano O, Ono J (2008) Comparison of the results of 2 targeting methods in gamma knife surgery for trigeminal neuralgia. J Neurosurg 109(Suppl):185–189PubMed
33.
Matsuda S, Nagano O, Serizawa T, Higuchi Y, Ono J (2010) Trigeminal nerve dysfunction after gamma knife surgery for trigeminal neuralgia: a detailed analysis. J Neurosurg 113(Suppl):184–190PubMed
34.
McNatt SA, Yu C, Giannotta SL, Zee CS, Zelman V, Apuzzo MLJ, Petrovich Z (2005) Gamma knife radiosurgery for trigeminal neuralgia. Neurosurgery 56:1295–1303PubMedCrossRef
35.
Morbidini-Gaffney S, Chung CT, Alpert TE, Newman N, Hahn SS, Shah H, Mitchell L, Bassano D, Darbar A, Bajwa SA, Hodge C (2006) Doses greater than 85 Gy and two isocenters in gamma knife surgery for trigeminal neuralgia: updated results. J Neurosurg 105(Suppl):107–111PubMed
36.
Nicol B, Regine WF, Courtney C, Meigooni A, Sanders M, Young B (2000) Gamma knife radiosurgery using 90 Gy for trigeminal neuralgia. J Neurosurg 93(Suppl 3):152–154PubMed
37.
Oh IH, Choi SK, Park BJ, Kim TS, Rhee BA, Lim YJ (2008) The treatment outcome of elderly patients with idiopathic trigeminal neuralgia: micro-vascular decompression versus gamma knife radiosurgery. J Korean Neurosurg Soc 44:199–204PubMedCrossRef
38.
Pan HC, Sheehan J, Huang CF, Sheu ML, Yang DY, Chiu WT (2010) Quality-of-life outcomes after gamma knife surgery for trigeminal neuralgia. J Neurosurg 191(Suppl):191–198
39.
Park SH, Hwang SK, Kang DH, Park J, Hwang JH, Sung JK (2010) The retrogasserian zone versus dorsal root entry zone: comparison of two targeting techniques of gamma knife radiosurgery for trigeminal neuralgia. Acta Neurochir (Wien) 152:1165–1170CrossRef
40.
Petit JH, Herman JM, Hagda S, DiBiase SJ, Chin LS (2003) Radiosurgical treatment of trigeminal neuralgia: evaluating quality of life and treatment outcomes. Int J Radiat Oncol Biol Phys 56:1147–1153PubMedCrossRef
41.
Pollock BE, Phuong LK, Gorman DA, Foote RL, Stafford SL (2002) Stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 97:347–353PubMedCrossRef
42.
Pollock BE (2006) Radiosurgery for trigeminal neuralgia: is sensory disturbance required for pain relief. J Neurosurg 105(Suppl):103–106PubMed
43.
Pollock BE, Schoeberl KA (2010) Prospective comparison of posterior fossa exploration and stereotactic radiosurgery dorsal root entry zone target as primary surgery for patients with idiopathic trigeminal neuralgia. Neurosurgery 67:633–639PubMedCrossRef
44.
Regis J, Metellus P, Hayashi M, Roussel P, Donnet A, Bille-Turc F (2006) Perspective controlled trial of gamma knife surgery for essential trigeminal neuralgia. J Neurosurg 104:913–924PubMedCrossRef
45.
Regis J, Arkha Y, Yomo S, Murata N, Roussel P, Donnet A, Peragut JC (2009) Radiosurgery in trigeminal neuralgia: long-term results and influence of operative nuances. Neurochirurgie 55:213–222 (article in French)PubMedCrossRef
46.
Riesenburger RI, Hwang SW, Schirmer CM, Zerris V, Wu JK, Mahn K, Klimo P Jr, Mignano J, Thompson CJ, Yao KC (2010) Outcomes following single-treatment gamma knife surgery for trigeminal neuralgia with a minimum 3-year follow-up. J Neurosurg 112:766–771PubMedCrossRef
47.
Rogers CL, Shetter AG, Fiedler JA, Smith KA, Han PP, Speiser BL (2000) Gamma knife radiosurgery for trigeminal neuralgia: the initial experience of the Barrow Neurological Institute. Int J Radiat Oncol Biol Phys 47:1013–1019PubMedCrossRef
48.
Sekula RF Jr, Frederickson AM, Jannetta PJ, Bhatia S, Quigley MR (2010) Microvascular decompression after failed gamma knife surgery for trigeminal neuralgia: a safe and effective rescue therapy? J Neurosurg 113:45–52PubMedCrossRef
49.
Shaya M, Jawahar A, Caldito G, Sin A, Willis BK, Nanda A (2004) Gamma knife radiosurgery for trigeminal neuralgia: a study of predictors of success, efficacy, safety, and outcome at LSUHSC. Surg Neurol 61:529–535PubMedCrossRef
50.
Sheehan J, Pan HC, Stroila M, Steiner L (2005) Gamma knife surgery for trigeminal neuralgia: outcomes and prognostic factors. J Neurosurg 102:434–441PubMedCrossRef
51.
Smith KA, Rogers CL (2002) Stereotactic radiosurgery for refractory trigeminal neuralgia. In: Pollock BE (ed) Contemporary stereotactic radiosurgery: Technique and evaluation. Futura, Armonk, pp 309–324
52.
Tatli M, Satici O, Kanpolat Y, Sindou M (2008) Various surgical modalities for trigeminal neuralgia: literature study of respective long-term outcomes. Acta Neurochir (Wien) 150:243–255CrossRef
53.
Tawk RG, Duffy-Fronckowiak M, Scott BE, Alberico RA, Diaz AZ, Podgorsak MB, Plunkett RJ, Fenstermaker RA (2005) Stereotactic gamma knife surgery for trigeminal neuralgia: detailed analysis of treatment response. J Neurosurg 102:442–449PubMedCrossRef
54.
Urgosik D, Liscak R, Novotny J Jr, Vymazal J, Vladyka V (2005) Treatment of essential trigeminal neuralgia with gamma knife surgery. J Neurosurg 102(Suppl):29–33PubMedCrossRef
55.
Vachhrajani S, Fawaz C, Mathieu D, Menard C, Cusimano MD, Gentili F, Hodaie M, Kenny B, Kulkarni AV, Laperriere N, Schwartz M, Tsao M, Bernstein M (2008) Complications of gamma knife surgery: an early report from 2 Canadian centers. J Neurosurg 109:2–7PubMed
56.
Verheul JB, Hanssens PEJ, Lie ST, Leenstra S, Piersma H, Beute GN (2010) Gamma knife surgery for trigeminal neuralgia: a review of 450 consecutive cases. J Neurosurg 113(Suppl):160–167PubMed
Metadata
Title
Stereotactic radiosurgery of essential trigeminal neuralgia using Leksell Gamma Knife model C with automatic positioning system
Technical nuances and evaluation of outcome in 130 patients with at least 2 years follow-up after treatment
Authors
Motohiro Hayashi
Mikhail Chernov
Noriko Tamura
Takaomi Taira
Masahiro Izawa
Shoji Yomo
Mariko Nagai
Cheng-Siu Chang
Pavel Ivanov
Manabu Tamura
Yoshihiro Muragaki
Yoshikazu Okada
Hiroshi Iseki
Kintomo Takakura
Publication date
01-10-2011
Publisher
Springer-Verlag
Published in
Neurosurgical Review / Issue 4/2011
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI
https://doi.org/10.1007/s10143-011-0330-9

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