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Subcutaneous Trigeminal Nerve Field Stimulation for Refractory Facial Pain
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Linear accelerator stereotactic radiosurgery for trigeminal neuralgia.
Leonor Varela-Lema1, Marisa Lopez-Garcia, Maria Maceira-Rozas
1Galician Agency for Health Technology Assessment, Galician Health Authority, Santiago de Compostela, Spain.
Pain Physician
|February 13, 2015
Summary
Linear-accelerator stereotactic radiosurgery offers an effective and safe option for drug-resistant trigeminal neuralgia, providing significant pain relief for most patients. Further research is needed to optimize treatment and identify patient subgroups who benefit most.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Pain Management
Background:
- Stereotactic radiosurgery (SRS) is an alternative for refractory trigeminal neuralgia (TN).
- Current evidence primarily relies on Gamma Knife SRS, a specialized intracranial neurosurgery device.
- Linear accelerators (LINACs) demonstrate comparable accuracy and dose distribution for SRS.
Purpose of the Study:
- To evaluate the effectiveness and safety of LINAC-based SRS for treating patients with refractory TN.
- To synthesize existing literature on LINAC-SRS outcomes for trigeminal neuralgia.
Main Methods:
- Systematic literature search across major electronic databases (PubMed, Embase, etc.) and grey literature.
- Inclusion of original studies in Spanish, French, English, and Portuguese.
- Qualitative data analysis due to the impossibility of pooled analysis, with critical assessment by two independent reviewers.
Main Results:
- Eleven case series were analyzed, showing satisfactory pain relief (75%-95.7%) in treated patients.
- Mean time to pain relief ranged from 8.5 days to 3.8 months.
- Adverse events included mild-moderate facial swelling/hypoesthesia (7.5%-51.9%), with rare instances of anesthesia dolorosa, hearing loss, brainstem edema, and neurotrophic keratoplasty.
Conclusions:
- LINAC-SRS appears to be an effective and safe therapeutic option for drug-resistant trigeminal neuralgia.
- Significant uncertainties remain regarding optimal treatment doses, target selection, and long-term recurrence.
- Further research is required to identify patient subgroups that would most benefit from LINAC-SRS.
