Results Of Gamma Knife Radiosurgery For Trigeminal Neuralgia Using A 90-gy Dose.Keywords: pain, trigeminal neuralgia, gamma knife, outcome, dose planningInteractive Manuscript
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What is the background behind your study?
The use of a 90-Gy dose for Gamma Knife treatment of trigeminal neuralgia (TN) remains controversial.
What is the purpose of your study?
We evaluate pain relief and morbidity in a series of patients treated by Gamma Knife for TN using for all patients a 90-Gy radiation dose, standardized dosimetric parameters (distance and dose delivered to the brainstem) and irradiation with LGK-C.
Describe your patient group.
We treated 204 patients for TN in our Gamma Knife center.
Describe what you did.
We treated the patients using a standardized methodology: 1) targeting using axial 1-mm sliced Gadolinium-enhanced T1-weighted and T2-weighted MRI); 2) distance of nerve >5mm between target and brainstem; 3) maximum radiation dose of 15 Gy delivered at the first 10mm³ of the brainstem; 4) maximum prescription dose of 90 Gy; 5) irradiation with LGK-C with APS. Patients were followed clinically for pain relief and complications; a minimum follow-up of 1 year was request to be included in the study.
Describe your main findings.
The follow-up data of 165 patients was available for analysis; mean follow-up was 24 months. Plugs were used for 59 patients (35%). Complete (100%) pain relief was reached for 123 patients (75%), 90% to 99% pain reduction for 21 patients (13%), 50% to 89% pain reduction for 8 patients (5%). No significant improvement of trigeminal pain following Gamma Knife treatment occurred in 13 patients (8%). A total of 143 patients (87%) have reduced or stopped their medication for TN at last follow-up. Moderate facial numbness occurred in 46 patients (28%) and bothersome dysesthesia in 19 patients (11%), including 11 patients treated with plugs. No other complication was observed.
Describe the main limitation of this study.
This is a retrospective study.
Describe your main conclusion.
Our dosimetric parameters achieved high rate of initial pain relief.
Describe the importance of your findings and how they can be used by others.
However, our treatment protocol is associated with a significant risk of numbness or bothersome dysesthesia, especially when plugs are used. We do not recommend using plugs when a 90-Gy dose is used.
The use of a 90-Gy dose for Gamma Knife treatment of trigeminal neuralgia (TN) remains controversial.
We evaluate pain relief and morbidity in a series of patients treated by Gamma Knife for TN using for all patients a 90-Gy radiation dose, standardized dosimetric parameters (distance and dose delivered to the brainstem) and irradiation with LGK-C.
We treated 204 patients for TN in our Gamma Knife center.
We treated the patients using a standardized methodology: 1) targeting using axial 1-mm sliced Gadolinium-enhanced T1-weighted and T2-weighted MRI); 2) distance of nerve >5mm between target and brainstem; 3) maximum radiation dose of 15 Gy delivered at the first 10mm³ of the brainstem; 4) maximum prescription dose of 90 Gy; 5) irradiation with LGK-C with APS. Patients were followed clinically for pain relief and complications; a minimum follow-up of 1 year was request to be included in the study.
The follow-up data of 165 patients was available for analysis; mean follow-up was 24 months. Plugs were used for 59 patients (35%). Complete (100%) pain relief was reached for 123 patients (75%), 90% to 99% pain reduction for 21 patients (13%), 50% to 89% pain reduction for 8 patients (5%). No significant improvement of trigeminal pain following Gamma Knife treatment occurred in 13 patients (8%). A total of 143 patients (87%) have reduced or stopped their medication for TN at last follow-up. Moderate facial numbness occurred in 46 patients (28%) and bothersome dysesthesia in 19 patients (11%), including 11 patients treated with plugs. No other complication was observed.
This is a retrospective study.
Our dosimetric parameters achieved high rate of initial pain relief.
However, our treatment protocol is associated with a significant risk of numbness or bothersome dysesthesia, especially when plugs are used. We do not recommend using plugs when a 90-Gy dose is used.
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