Top

Published in:

01-12-2024 | Trigeminal Neuralgia | Original Article

Repeat Gamma Knife radiosurgery for recurrent trigeminal neuralgia in patients with multiple sclerosis: a single-center retrospective study

Authors: Andrea Franzini, Piero Picozzi, Ali Baram, Pierina Navarria, Marta Scorsetti, Stefano Tomatis, Federico Pessina

Published in: Acta Neurochirurgica | Issue 1/2024

Abstract

Purpose

Gamma Knife radiosurgery (GKRS) has emerged as an effective treatment option for trigeminal neuralgia (TN) in patients with multiple sclerosis (MS). To date, the outcomes of repeat GKRS for patients with TN and MS with recurrent pain have been investigated in a few patients. This study aims to report the outcomes and predictive factors of pain reduction for MS patients undergoing repeat GKRS for recurrent TN.

Methods

Eighteen patients with MS underwent repeat GKRS for recurrent TN. A retrospective chart review and telephone interviews were conducted to determine background medical history, dosimetric data, and outcomes of the procedure. Facial pain and sensory function were evaluated using the Barrow Neurological Institute (BNI) scales.

Results

Fifteen patients achieved a BNI pain score of IIIa or better, indicating pain reduction, within a median period of 21 days after repeat GKRS. The maximum dose for repeat GKRS ranged from 70 to 85 Gy. Pain recurred in 5 patients after a median period of 12 months after GKRS. Percentages of patients with pain reduction at 1, 2, 3, 5, and 7 years were 60%, 60%, 50%, 50%, and 50%, respectively. Older age at repeat GKRS predicted sustained pain reduction (P = 0.01). Seven patients developed facial sensory disturbances, which were bothersome in two patients.

Conclusions

Repeat GKRS may be used as an effective treatment modality for prolonging the duration of pain reduction time in patients with MS and TN. After repeat GKRS, facial sensory disturbances are common; however, they are often not bothersome.

Available only for authorised users

Alvarez-Pinzon AM, Wolf AL, Swedberg HN, Barkley KA, Cucalon J, Curia L, Valerio JE (2017) Comparison of percutaneous retrogasserian balloon compression and Gamma Knife radiosurgery for the treatment of trigeminal neuralgia in multiple sclerosis. World Neurosurg 97:590–594. https://doi.org/10.1016/j.wneu.2016.10.028CrossRefPubMed

Arnold M (2018) Headache classification committee of the international headache society (IHS) the international classification of headache disorders. Cephalalgia 38:1–211CrossRef

Aubuchon AC, Chan MD, Lovato JF, Balamucki CJ, Ellis TL, Tatter SB, McMullen KP, Munley MT, Deguzman AF, Ekstrand KE et al (2011) Repeat Gamma Knife radiosurgery for trigeminal neuralgia. Int J Radiat Oncol Biol Phys 81:1059–1065. https://doi.org/10.1016/j.ijrobp.2010.07.010CrossRefPubMed

Brisman R (2003) Repeat Gamma Knife radiosurgery for trigeminal neuralgia. Stereotact Funct Neurosurg 81:43–49. https://doi.org/10.1159/000075103CrossRefPubMed

Diwanji T, Dhople A, Chin L, Maggio W, Adams J, Regine W, Kwok Y (2010) Long-term outcome of Gamma Knife stereotactic radiosurgery for multiple sclerosis associated trigeminal neuralgia. Int J Radiat Oncol Biol Phys 78:S264–S265CrossRef

Franzini A, Moosa S, D'Ammando A, Bono B, Scheitler-Ring K, Ferroli P, Messina G, Prada F, Franzini A (2019) The neurosurgical treatment of craniofacial pain syndromes: current surgical indications and techniques. Neurol Sci 40:159–168. https://doi.org/10.1007/s10072-019-03789-4CrossRefPubMed

Franzini A, Tropeano MP, Olei S, De Robertis M, Rossini Z, Attuati L, Milani D, Pessina F, Clerici E, Navarria P et al (2021) Gamma Knife radiosurgery for the treatment of trigeminal neuralgia in patients with multiple sclerosis: a single-center retrospective study and literature review. World Neurosurg. https://doi.org/10.1016/j.wneu.2021.02.074

Helis CA, Lucas JT Jr, Bourland JD, Chan MD, Tatter SB, Laxton AW (2015) Repeat radiosurgery for trigeminal neuralgia. Neurosurgery 77:755–761; discussion 761. https://doi.org/10.1227/NEU.0000000000000915CrossRefPubMed

Helis CA, McTyre E, Munley MT, Bourland JD, Lucas JT, Cramer CK, Tatter SB, Laxton AW, Chan MD (2019) Gamma Knife radiosurgery for multiple sclerosis-associated trigeminal neuralgia. Neurosurgery 85:E933–E939. https://doi.org/10.1093/neuros/nyz182CrossRefPubMedPubMedCentral

10.

Herman JM, Petit JH, Amin P, Kwok Y, Dutta PR, Chin LS (2004) Repeat Gamma Knife radiosurgery for refractory or recurrent trigeminal neuralgia: treatment outcomes and quality-of-life assessment. Int J Radiat Oncol Biol Phys 59:112–116. https://doi.org/10.1016/j.ijrobp.2003.10.041CrossRefPubMed

11.

Huang E, Teh BS, Zeck O, Woo SY, Lu HH, Chiu JK, Butler EB, Gormley WB, Carpenter LS (2002) Gamma Knife radiosurgery for treatment of trigeminal neuralgia in multiple sclerosis patients. Stereotact Funct Neurosurg 79:44–50. https://doi.org/10.1159/000069503CrossRefPubMed

12.

Leduc W, Mathieu D, Adam E, Ferreira R, Iorio-Morin C (2023) Gamma Knife stereotactic radiosurgery for trigeminal neuralgia secondary to multiple sclerosis: a case-control study. Neurosurgery. https://doi.org/10.1227/neu.0000000000002440

13.

Mathieu D, Effendi K, Blanchard J, Seguin M (2012) Comparative study of Gamma Knife surgery and percutaneous retrogasserian glycerol rhizotomy for trigeminal neuralgia in patients with multiple sclerosis. J Neurosurg 117(Suppl):175–180. https://doi.org/10.3171/2012.6.GKS12987CrossRefPubMed

14.

Mohammad-Mohammadi A, Recinos PF, Lee JH, Elson P, Barnett GH (2013) Surgical outcomes of trigeminal neuralgia in patients with multiple sclerosis. Neurosurgery 73:941–950; discussion 950. https://doi.org/10.1227/NEU.0000000000000128CrossRefPubMed

15.

Montano N, Papacci F, Cioni B, Di Bonaventura R, Meglio M (2013) What is the best treatment of drug-resistant trigeminal neuralgia in patients affected by multiple sclerosis? A literature analysis of surgical procedures. Clin Neurol Neurosurg 115:567–572. https://doi.org/10.1016/j.clineuro.2012.07.011CrossRefPubMed

16.

Park KJ, Kondziolka D, Berkowitz O, Kano H, Novotny J Jr, Niranjan A, Flickinger JC, Lunsford LD (2012) Repeat Gamma Knife radiosurgery for trigeminal neuralgia. Neurosurgery 70:295–305; discussion 305. https://doi.org/10.1227/NEU.0b013e318230218eCrossRefPubMed

17.

Pollock BE, Foote RL, Link MJ, Stafford SL, Brown PD, Schomberg PJ (2005) Repeat radiosurgery for idiopathic trigeminal neuralgia. Int J Radiat Oncol Biol Phys 61:192–195. https://doi.org/10.1016/j.ijrobp.2004.03.019CrossRefPubMed

18.

Przybylowski CJ, Cole TS, Baranoski JF, Little AS, Smith KA, Shetter AG (2018) Radiosurgery for multiple sclerosis-related trigeminal neuralgia: retrospective review of long-term outcomes. J Neurosurg 1-8. https://doi.org/10.3171/2018.5.JNS173194

19.

Ramsaransing G, Zwanikken C, De Keyser J (2000) Worsening of symptoms of multiple sclerosis associated with carbamazepine. BMJ 320:1113CrossRefPubMedPubMedCentral

20.

Regis J, Tuleasca C, Resseguier N, Carron R, Donnet A, Gaudart J, Levivier M (2016) Long-term safety and efficacy of Gamma Knife surgery in classical trigeminal neuralgia: a 497-patient historical cohort study. J Neurosurg 124:1079–1087. https://doi.org/10.3171/2015.2.JNS142144CrossRefPubMed

21.

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 47:1013–1019. https://doi.org/10.1016/s0360-3016(00)00513-7CrossRefPubMed

22.

Rogers CL, Shetter AG, Ponce FA, Fiedler JA, Smith KA, Speiser BL (2002) Gamma Knife radiosurgery for trigeminal neuralgia associated with multiple sclerosis. J Neurosurg 97:529–532. https://doi.org/10.3171/jns.2002.97.supplementCrossRefPubMed

23.

Spina A, Nocera G, Boari N, Iannaccone S, Mortini P (2021) Efficacy of Gamma Knife radiosurgery in the management of multiple sclerosis-related trigeminal neuralgia: a systematic review and meta-analysis. Neurosurg Rev 44:3069–3077. https://doi.org/10.1007/s10143-021-01507-3CrossRefPubMed

24.

Tuleasca C, Carron R, Resseguier N, Donnet A, Roussel P, Gaudart J, Levivier M, Regis J (2014) Multiple sclerosis-related trigeminal neuralgia: a prospective series of 43 patients treated with Gamma Knife surgery with more than one year of follow-up. Stereotact Funct Neurosurg 92:203–210. https://doi.org/10.1159/000362173CrossRefPubMed

25.

Tuleasca C, Carron R, Resseguier N, Donnet A, Roussel P, Gaudart J, Levivier M, Regis J (2014) Repeat Gamma Knife surgery for recurrent trigeminal neuralgia: long-term outcomes and systematic review. J Neurosurg 121(Suppl):210–221. https://doi.org/10.3171/2014.8.GKS141487CrossRefPubMed

26.

Tuleasca C, Regis J, Sahgal A, De Salles A, Hayashi M, Ma L, Martinez-Alvarez R, Paddick I, Ryu S, Slotman BJ et al (2018) Stereotactic radiosurgery for trigeminal neuralgia: a systematic review. J Neurosurg 130:733–757. https://doi.org/10.3171/2017.9.JNS17545CrossRefPubMed

27.

Xu Z, Mathieu D, Heroux F, Abbassy M, Barnett G, Mohammadi AM, Kano H, Caruso J, Shih HH, Grills IS et al (2019) Stereotactic radiosurgery for trigeminal neuralgia in patients with multiple sclerosis: a multicenter study. Neurosurgery 84:499–505. https://doi.org/10.1093/neuros/nyy142CrossRefPubMed

28.

Zakrzewska JM, Akram H (2011) Neurosurgical interventions for the treatment of classical trigeminal neuralgia. Cochrane Database Syst Rev 2011:CD007312. https://doi.org/10.1002/14651858.CD007312.pub2CrossRefPubMedPubMedCentral

29.

Zakrzewska JM, Wu J, Brathwaite TS (2018) A systematic review of the management of trigeminal neuralgia in patients with multiple sclerosis. World Neurosurg 111:291–306. https://doi.org/10.1016/j.wneu.2017.12.147CrossRefPubMed

30.

Zeydan B, Kantarci OH (2020) Impact of age on multiple sclerosis disease activity and progression. Curr Neurol Neurosci Rep 20:24. https://doi.org/10.1007/s11910-020-01046-2CrossRefPubMed

31.

Zorro O, Lobato-Polo J, Kano H, Flickinger JC, Lunsford LD, Kondziolka D (2009) Gamma Knife radiosurgery for multiple sclerosis-related trigeminal neuralgia. Neurology 73:1149–1154. https://doi.org/10.1212/WNL.0b013e3181bacfb4CrossRefPubMed

Title: Repeat Gamma Knife radiosurgery for recurrent trigeminal neuralgia in patients with multiple sclerosis: a single-center retrospective study
Authors: Andrea Franzini
Piero Picozzi
Ali Baram
Pierina Navarria
Marta Scorsetti
Stefano Tomatis
Federico Pessina
Publication date: 01-12-2024
Publisher: Springer Vienna
Keywords: Trigeminal Neuralgia
Multiple Sclerosis
Published in: Acta Neurochirurgica / Issue 1/2024
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-024-05913-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Repeat Gamma Knife radiosurgery for recurrent trigeminal neuralgia in patients with multiple sclerosis: a single-center retrospective study

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2024

Bone resorption around the annular closure device during a postoperative follow-up of 8 years

Cervical dorsal rhizotomy for upper limbs spasticity. Case report

Acute evacuation of 54 intracerebral hematomas (aICH) during the microsurgical clipping of a ruptured middle cerebral artery bifurcation aneurysm—illustration of the individual clinical courses and outcomes with a serial brain CT/MRI panel until 12 months

Alexis retractor efficacy in transthoracic thoracoscopically assisted discectomy for thoracic disc herniations

Technical note: preliminary surgical experience with a new implantable epicranial stimulation device for chronic focal cortex stimulation in drug-resistant epilepsy

Oculomotor nerve cavernous malformation: case report and operative video