Document Detail


Trigeminal nerve radiosurgical treatment in intractable chronic cluster headache: unexpected high toxicity.
MedLine Citation:
PMID:  17277687     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: We have previously reported short-term results of a prospective open trial designed to evaluate trigeminal nerve radiosurgical treatment in intractable chronic cluster headache (CCH). Medium- and long-term results have not yet been reported. METHODS: Ten patients presenting with a severe and drug-resistant CCH were enrolled (nine men, one woman). The radiosurgical treatment was performed according to the technique usually used for trigeminal neuralgia in our department. A single 4-mm shot was positioned at the level of the cisternal portion of the trigeminal nerve. The median distance between the center of the shot and the emergence of the nerve was 9.35 mm (range, 7.5-13.3 mm). The median of this maximum dose to the brainstem was 8.0 Gy (range, 4.0-11.1 Gy). Mean age was 49.8 years (range, 32-77 yr). Mean duration of the CCH was 9 years (range, 2-33 yr). The mean follow-up period was 36.3 months (range, 24-48 mo). RESULTS: Two patients had complete relief of CCH. One patient had a good result with evolution in an episodic form. Seven patients had no improvement. Nine patients developed a new trigeminal nerve disturbance: three developed paresthesia with no hypoesthesia and six developed hypoesthesia, including two patients with deafferentation pain. Only one patient had neither paresthesia nor hypoesthesia. CONCLUSION: We confirmed, with medium- and long-term evaluation, the high rate of toxicity and failure of the technique. The high toxicity, despite a methodology identical to the one used in trigeminal neuralgia, leads us to suspect an underlying specificity of the nerve in CCH. We do not recommend radiosurgery for treatment of intractable CCH.
Authors:
Anne Donnet; Manabu Tamura; Dominique Valade; Jean Régis
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  59     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2006 Dec 
Date Detail:
Created Date:  2007-02-05     Completed Date:  2007-02-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1252-7; discussion 1257     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Hôpital la Timone, Marseille, France. adonnet@AP-HM.fr
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Chronic Disease
Cluster Headache / prevention & control*
Female
Humans
Male
Middle Aged
Radiation Injuries / diagnosis,  etiology*
Radiotherapy / adverse effects*
Treatment Outcome
Trigeminal Nerve / surgery*
Trigeminal Nerve Diseases / diagnosis,  etiology*

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


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