Document Detail

Stereotactic radiosurgery for primary trigeminal neuralgia using the Leksell Gamma unit.
MedLine Citation:
PMID:  12007276     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Previous papers have reported Gamma Knife radiosurgery to be a safe, effective method for primary trigeminal neuralgia. Since November 1996, we have treated primary trigeminal neuralgia using the Leksell Gamma Knife at the Tianjin Medical University. The present study reports clinical results of Gamma Knife radiosurgery in the treatment of trigeminal neuralgia in 80 cases. METHODS: The mean patient age was 67 years (range 32-92), the mean duration of facial pain was 7.6 years (range 1.5-29). The male:female ratio was 31:49. The right side of the face was involved in 45 patients (56.25%) and the left side in 30 cases (37.5%), with bilateral involvement in 5 cases (6.25%). Under local anesthesia, all patients underwent stereotactic MRI to identify the trigeminal nerve. A single isocenter, using a 4-mm collimator, was positioned at the sensory root of the trigeminal nerve entry zone of the pons, 4-6 mm from the brainstem surface, so that no more than the 20% isodose was administered to the brainstem. The maximum dose was between 70 and 90 Gy, with a mean of 75.6 Gy. For bilateral trigeminal neuralgia, two separate matrices were employed, and bilateral Gamma Knife radiosurgery was performed on the same day. RESULTS: Follow-up ranged from 12 to 43 months (mean 23.7 months). Neurological evaluation indicated excellent response in 42 cases (52.5%), good response in 25 cases (31.25%), effective response in 8 cases (10%), so the total pain control rate was 93.75%. The latency from Gamma Knife surgery to pain relief ranged from 1 to 120 days (mean 22 days). Among the 75 patients 7 with pain control experienced pain recurrence 5-26 months after being completely free from pain. A second Gamma Knife radiosurgery was performed in 7 recurrent cases and 5 patients with treatment failure. A maximal dose ranging from 70 to 80 Gy was given (mean 74.2 Gy). After a mean follow-up of 18 months (8-33 months), 9 patients achieved excellent results, and 2 had good results. The latency interval to pain relief ranged from 1 to 120 days (mean 15 days). Nine patients developed new facial numbness, while no other complication appeared in the remainder of the patients. CONCLUSIONS: Gamma Knife radiosurgery is a safe and effective method in the treatment of trigeminal neuralgia once diagnosis is established.
L G Zheng; D S Xu; C S Kang; Z Y Zhang; Y H Li; Y P Zhang; D Liu; Q Jia
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Stereotactic and functional neurosurgery     Volume:  76     ISSN:  1011-6125     ISO Abbreviation:  Stereotact Funct Neurosurg     Publication Date:  2001  
Date Detail:
Created Date:  2002-05-14     Completed Date:  2002-07-01     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8902881     Medline TA:  Stereotact Funct Neurosurg     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  29-35     Citation Subset:  IM    
Copyright Information:
Copyright 2002 S. Karger AG, Basel
Gamma Knife Center, Department of Neurosurgery, Second Hospital of the Tianjin Medical University, People's Republic of China.
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MeSH Terms
Aged, 80 and over
Follow-Up Studies
Middle Aged
Radiosurgery / instrumentation*,  methods*,  statistics & numerical data
Trigeminal Neuralgia / physiopathology,  surgery*

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