Document Detail


High-dose trigeminal neuralgia radiosurgery associated with increased risk of trigeminal nerve dysfunction.
MedLine Citation:
PMID:  11440460     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Stereotactic radiosurgery is being used with more frequency in the management of patients with trigeminal neuralgia. To improve facial pain outcomes, many centers have increased the prescribed radiation dose to the trigeminal nerve. METHODS: Between April 1997 and December 1999, 68 patients underwent radiosurgery for trigeminal neuralgia with use of the Leksell gamma knife (Elekta Instruments, Norcross, GA) and a single 4-mm isocenter of radiation. Twenty-seven patients (40%) received 70 Gy (low dose) of irradiation and 41 patients (60%) received 90 Gy (high dose). The groups were similar with regard to age, sex, duration of pain, number of prior surgeries, and preexisting trigeminal deficits. The primary facial pain outcomes for analysis were excellent (pain-free, no medications) and good (pain-free, reduced medications). The mean length of follow-up after radiosurgery was 14.4 months (range, 2-36 mo). RESULTS: At last follow-up examination, 11 (41%) of the 27 patients with low-dose radiosurgery remained pain-free compared with 25 (61%) of the 41 patients with high-dose radiosurgery (P = 0.17). Additional surgery was performed in 12 low-dose patients (44%) and 8 high-dose patients (20%) (P = 0.05). High-dose radiosurgery was associated with an increased rate of permanent trigeminal nerve dysfunction (54% versus 15%, P = 0.003). Bothersome dysesthesias occurred in 13 high-dose patients (32%), whereas only 1 low-dose patient had this complication (P = 0.01). Three high-dose patients (8%) developed corneal numbness after radiosurgery. Pain recurred with more frequency in patients not developing trigeminal nerve dysfunction after radiosurgery (9 of 22 patients, 41 %) compared with those who sustained facial numbness, paresthesias, or dysesthesias (4 of 27 patients, 15%); however, the difference was not statistically significant (P = 0.08). CONCLUSION: Higher doses of radiation may correlate with better facial pain outcomes after radiosurgery for trigeminal neuralgia. However, the incidence of significant trigeminal nerve dysfunction is markedly increased after radiosurgery for patients receiving high-dose radiosurgery. Because of the nonselective nature of this ablative technique, dose prescription should be limited to less than 90 Gy.
Authors:
B E Pollock; L K Phuong; R L Foote; S L Stafford; D A Gorman
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  49     ISSN:  0148-396X     ISO Abbreviation:  Neurosurgery     Publication Date:  2001 Jul 
Date Detail:
Created Date:  2001-07-06     Completed Date:  2001-11-01     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  58-62; discussion 62-4     Citation Subset:  IM    
Affiliation:
Department of Neurological Surgery, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA. pollock.bruce@mayo.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Dose-Response Relationship, Radiation
Facial Pain / physiopathology
Female
Humans
Incidence
Male
Postoperative Period
Radiosurgery / adverse effects*
Reoperation
Risk Factors
Stereotaxic Techniques / adverse effects
Trigeminal Nerve Diseases / epidemiology,  etiology*
Trigeminal Neuralgia / physiopathology,  surgery*
Comments/Corrections
Comment In:
Neurosurgery. 2002 Jun;50(6):1401-2; author reply 1402-3   [PMID:  12051192 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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