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Subcutaneous Trigeminal Nerve Field Stimulation for Refractory Facial Pain
Published on: May 10, 2017
Repeat gamma knife radiosurgery for trigeminal neuralgia
Adam C Aubuchon1, Michael D Chan, James F Lovato
1Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. acaubuchon@gmail.com
International Journal of Radiation Oncology, Biology, Physics
|October 12, 2010
Summary
Repeat Gamma Knife radiosurgery (GKRS) offers pain relief for trigeminal neuralgia but increases facial numbness. Higher doses predict success and numbness, with numbness improving pain.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Pain Management
Background:
- Trigeminal neuralgia (TN) is a debilitating facial pain condition.
- Recurrent or persistent TN may require repeat treatments.
- Gamma Knife stereotactic radiosurgery (GKRS) is a treatment option for TN.
Purpose of the Study:
- To evaluate the efficacy and toxicity of repeat GKRS for recurrent TN.
- To identify prognostic factors for treatment success and toxicity in repeat GKRS.
Main Methods:
- Retrospective analysis of 37 patients undergoing repeat GKRS between 1999-2007.
- Dosimetric variables analyzed: dorsal root entry zone dose, pons surface dose, distal nerve dose.
- Multivariate analysis to identify predictors of pain relief and facial numbness.
Main Results:
- 81% of patients achieved >50% pain relief after repeat GKRS.
- 57% experienced trigeminal dysfunction, with 5% experiencing significant toxicity.
- Higher cumulative dorsal root entry zone and pons surface doses predicted post-GKRS numbness.
- Post-GKRS numbness correlated with improved pain relief.
Conclusions:
- Repeat GKRS is a viable option for recurrent TN, balancing pain relief with potential nerve dysfunction.
- Dose escalation is associated with increased efficacy and toxicity.
- Careful patient selection and dose planning are crucial for optimizing outcomes.
