Document Detail

Microsurgical outcomes after failed repeated Gamma Knife surgery for refractory trigeminal neuralgia.
MedLine Citation:
PMID:  18503343     Owner:  NLM     Status:  MEDLINE    
OBJECT: The results of microsurgery in patients with trigeminal neuralgia (TN) after failure of repeated Gamma Knife surgery (GKS) have not previously been examined. The effects of microvascular decompression (MVD) in patients in whom repeated GKS has failed are reported. METHODS: Between 1999 and 2004, eight patients (five women and three men) who underwent repeated GKS and experienced treatment failure subsequently underwent MVD. These patients underwent MVD for recurrent or residual intractable trigeminal pain. The duration of facial pain before MVD ranged from 0.8 to 13 years (mean 5.2 years). The total treatment dose administered ranged from 110 to 140 Gy (mean 129 Gy). The mean age was 59.5 years (range 44-68 years). Seven patients in whom the offending vessel (five arteries and two veins) was located at the nerve entry zone improved with variable pain relief after MVD. One patient in whom the vessel could not be identified did not improve. Intraoperatively, there were no signs in any patient of radiation-induced damage such as thickening of arachnoid membrane. In one patient a segment of atherosclerotic plaque was discovered at the nerve entry zone. Two patients experienced numbness at 1 and 3 months after MVD. CONCLUSIONS: Microvascular decompression is an effective treatment for patients with TN in whom repeated GKS has failed. Previous radiation treatment did not negatively impact operative difficulty or risk to the patient in this small series. Radiosurgery may induce vascular injury and cause pain recurrence.
Chuan-Fu Huang; Jim-Chao Chuang; Hsien-Tang Tu; Ming-Chih Chou
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  105 Suppl     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2006 Dec 
Date Detail:
Created Date:  2008-05-27     Completed Date:  2009-04-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  117-9     Citation Subset:  AIM; IM    
Institute of Medicine, Chung-Shan Medical University Hospital, Taichung, Taiwan.
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MeSH Terms
Cohort Studies
Decompression, Surgical*
Middle Aged
Pain, Intractable / etiology,  pathology,  prevention & control*
Radiotherapy Dosage
Retrospective Studies
Treatment Failure
Trigeminal Neuralgia / etiology,  pathology,  surgery*
Vascular Surgical Procedures*

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