Document Detail


Influence of nerve radiation dose in the incidence of trigeminal dysfunction after trigeminal neuralgia radiosurgery.
MedLine Citation:
PMID:  17415205     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The authors conducted a comparative study to analyze dosimetry and results to understand the significant difference in the rate of trigeminal dysfunction after gamma knife radiosurgery for trigeminal neuralgia between two centers using the same target. METHODS: The data of 358 patients (109 patients from Brussels and 259 patients from Marseilles) were analyzed. Three different dosimetric strategies were found: treatment with less than 90 Gy and no selective beam channel blocking (Group 1; patients from Marseilles only), treatment with 90 Gy and no selective beam channel blocking (Group 2; patients from Brussels and Marseilles), or treatment with 90 Gy and use of selective beam channel blocking (Group 3; patients from Brussels only). RESULTS: The prescription dose and the use of selective beam channel blocking have been significantly associated with a higher energy received by the retrogasserian trigeminal nerve root. The different radiation dose delivered to the nerve root in these three groups of patients was significantly associated with the incidence of mild (15, 21, and 49% for Groups 1, 2, and 3, respectively) and bothersome (1.4, 2.4, and 10% for Groups 1, 2, and 3, respectively) trigeminal dysfunction. The good and excellent rates of pain relief were 81 and 66%, respectively, for Group 1, 85 and 77%, respectively, for Group 2, and 90 and 84%, respectively, for Group 3, and were also related to the amount of energy received by nerve root volume. CONCLUSION: Using a similar target, the incidence of trigeminal dysfunction and the pain relief rate can vary according to the radiation energy received by the retrogasserian part of the trigeminal nerve root. The prescription dose and the use of beam channel blocking modify the integrated dose delivered to the nerve and may contribute to the different rates of trigeminal numbness and pain outcome. The radiobiological effect of gamma knife radiosurgery may be related to the energy delivered to nerve root volume, rather than to the maximal dose delivered.
Authors:
Nicolas Massager; Noriko Murata; Manabu Tamura; Daniel Devriendt; Marc Levivier; Jean Régis
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Publication Detail:
Type:  Controlled Clinical Trial; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  60     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2007 Apr 
Date Detail:
Created Date:  2007-04-06     Completed Date:  2007-05-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  681-7; discussion 687-8     Citation Subset:  IM    
Affiliation:
Gamma Knife Center, Université Libre de Bruxelles, Brussels, Belgium. nmassage@ulb.ac.be
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MeSH Terms
Descriptor/Qualifier:
Aged
Belgium / epidemiology
Dose-Response Relationship, Radiation
Female
Humans
Incidence
Male
Middle Aged
Pain Measurement / radiation effects*,  statistics & numerical data*
Radiation Dosage
Radiosurgery / statistics & numerical data*
Risk Assessment / methods*
Risk Factors
Treatment Outcome
Trigeminal Neuralgia / diagnosis*,  epidemiology,  surgery*

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


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