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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
Kyung-Jae Park1, Douglas Kondziolka, Oren Berkowitz
1Department of Neurological Surgery and Center for Image-Guided Neurosurgery, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA.
Neurosurgery
|August 4, 2011
Summary
Repeat Gamma Knife Stereotactic Radiosurgery (GKSR) effectively manages recurrent trigeminal neuralgia (TN), offering similar pain relief rates to the initial procedure. Optimal outcomes are seen in patients with prior good pain control and those developing new sensory deficits post-treatment.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Pain Management
Background:
- Trigeminal neuralgia (TN) recurrence after initial Gamma Knife Stereotactic Radiosurgery (GKSR) necessitates further treatment.
- Evaluating repeat GKSR outcomes is crucial for managing persistent or recurring TN.
Purpose of the Study:
- To assess the efficacy and safety of repeat Gamma Knife Stereotactic Radiosurgery (GKSR) in patients with recurrent trigeminal neuralgia (TN).
Main Methods:
- Retrospective review of 119 patients with recurrent TN undergoing repeat GKSR.
- Analysis of patient demographics, treatment doses (median 70 Gy target, 145 Gy cumulative), intervals, and follow-up (median 48 months).
Main Results:
- Initial pain relief (Barrow Neurological Institute pain score I-IIIb) achieved in 87% of patients.
- Sustained pain relief observed in 87.8% at 1 year, 69.8% at 3 years, and 44.2% at 5 years.
- Facial sensory dysfunction occurred in 21% within 18 months; higher cumulative doses (≥ 44 Gy) correlated with sensory loss.
Conclusions:
- Repeat GKSR offers comparable pain relief to the first procedure for recurrent TN.
- Patients with prior good pain control and those developing new trigeminal sensory dysfunction showed the best response.
- Repeat GKSR is a viable option for managing recurrent trigeminal neuralgia.
