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Brainstem and trigeminal nerve changes after radiosurgery for trigeminal pain
Alessandra Gorgulho1, Antonio A F De Salles, David McArthur
1Division of Neurosurgery, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095, USA.
Surgical Neurology
|August 1, 2006
Summary
Radiological changes on follow-up MRI after stereotactic radiosurgery (SRS) for trigeminal neuralgia (TN) can predict pain relief. Pons enhancement on MRI is associated with better pain outcomes, though paresthesias may increase.
Area of Science:
- Neurosurgery
- Radiology
- Neurology
Background:
- Trigeminal neuralgia (TN) is a chronic pain condition.
- Stereotactic radiosurgery (SRS) is a treatment option for TN.
- Radiological changes on follow-up MRI after SRS require evaluation.
Purpose of the Study:
- To assess the significance of radiological changes observed on follow-up MRIs after SRS for TN.
- To correlate these changes with pain outcomes and complications.
Main Methods:
- Retrospective analysis of 37 patients with TN treated with SRS.
- Patients were followed up for paresthesias, pain outcome, and complications.
- MRI findings, including enhancement patterns, were analyzed.
- Correlation between radiological findings, pain relief, and complications was assessed.
Main Results:
- 67% of patients achieved excellent/good pain relief at 13 months.
- MRI enhancement was observed in 56.75% of cases.
- Pons enhancement correlated significantly with pain relief (P = .0087).
- Paresthesias occurred in 66.6% of patients and correlated with enhancement (P = .02).
Conclusions:
- Pons enhancement on follow-up MRI appears to be a positive prognostic indicator for pain relief in TN patients treated with SRS.
- Irradiated pons volume did not predict enhancement.
- Targeting the brainstem-trigeminal nerve interface may improve pain outcomes but can increase the incidence of paresthesias.