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Subcutaneous Trigeminal Nerve Field Stimulation for Refractory Facial Pain
Published on: May 10, 2017
Repeated Gamma Knife surgery for refractory trigeminal neuralgia
Chuan-Fu Huang1, Jim-Chao Chuang, Hsien-Tang Tu
1Department of Neurosurgery, Chung-Shan Medical University Hospital, Taichung, Taiwan, Republic of China.
Journal of Neurosurgery
|December 1, 2006
Summary
Repeated Gamma Knife surgery (GKS) for trigeminal neuralgia (TN) offers pain relief for most patients. Higher doses may increase facial numbness, indicating a need for further research on optimal GKS treatment for TN.
Area of Science:
- Neurosurgery
- Radiation Oncology
Background:
- Trigeminal neuralgia (TN) is a chronic pain condition.
- Repeated Gamma Knife surgery (GKS) is used for refractory TN.
- Optimal dosing and nerve tolerance for repeated GKS are not well-established.
Purpose of the Study:
- To evaluate the efficacy and safety of repeated Gamma Knife surgery (GKS) for trigeminal neuralgia (TN).
- To assess the relationship between radiation dose and outcomes in repeated GKS for TN.
Main Methods:
- Retrospective analysis of 28 patients with recurrent or residual TN undergoing repeated GKS between 1999 and 2004.
- Targeting the trigeminal nerve entry zone with a 4-mm collimator.
- Administering maximal doses of 40-76 Gy and additive doses of 110-152 Gy.
Main Results:
- 68% of patients (19/28) reported pain relief, with 13 becoming medication-free.
- 9 patients experienced recurrent or residual pain after a median of 12 months.
- 10 patients developed new facial numbness, associated with additive doses > 115 Gy (p=0.047).
Conclusions:
- Repeated GKS provides durable pain relief for a majority of TN patients.
- Higher additive doses (> 115 Gy) are linked to increased facial numbness.
- Prospective trials are necessary to fully evaluate GKS efficacy and long-term complications in TN.
