Gamma Knife Radiosurgery for Idiopathic Trigeminal Neuralgia: Does the Status of Offending Vessels Influence Pain Control or Side Effects?

Hyun Ho Jung, Chang Kyu Park, Na Young Jung, Minsoo Kim, Won Seok Chang, Jin Woo Chang

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective To evaluate pain control and side effects after gamma knife radiosurgery (GKRS) for classical idiopathic trigeminal neuralgia (TN) with or without neurovascular compression (NVC). Methods This study included 47 patients with type 1 idiopathic TN and Barrow Neurological Institute (BNI) pain class IV or V who were treated with GKRS, with a maximum dose of 85 Gy targeting the root entry zone, as an initial treatment modality between January 2005 and March 2015. A retrospective analysis of NVC status, pain control, side effects, recurrence, and cross-sectional area was conducted. Results During follow-up (median, 21.5 months; range, 3–119 months), 36 of the 47 patients (76.6%) demonstrated good outcomes (i.e., improved to below BNI class IIIa). Twenty-two patients did not have NVC (group A) and 25 had NVC (group B). The rate of good outcomes did not differ significantly between the 2 groups (group A, 86.4% [19 of 22] vs. group B, 68% [17 of 25]; P = 0.138). The number of cases in BNI class I or II and the number of recurrences also did not differ significantly between the 2 groups (P = 0.532 and 0.786, respectively). The mean area was 8.64 ± 2.59 mm3 in nondeviated cases (n = 27) and 2.59 ± 1.68 mm3 in deviated (n = 10). Side effects were significantly more frequent in deviated cases (80% [8 of 10]) than in nondeviated cases (25.9% [7 of 27]; P = 0.003). Conclusions NVC is not a predictive factor for pain control after GKRS for the treatment of idiopathic TN. Side effects may occur more frequently in patients with NVC at the target coordinate when a root entry zone is used, but the subjective symptoms are not always bothersome.

Original languageEnglish
Pages (from-to)687-693
Number of pages7
JournalWorld Neurosurgery
Volume104
DOIs
Publication statusPublished - 2017 Aug

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Trigeminal Neuralgia
Radiosurgery
Pain
Recurrence
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Jung, Hyun Ho ; Park, Chang Kyu ; Jung, Na Young ; Kim, Minsoo ; Chang, Won Seok ; Chang, Jin Woo. / Gamma Knife Radiosurgery for Idiopathic Trigeminal Neuralgia : Does the Status of Offending Vessels Influence Pain Control or Side Effects?. In: World Neurosurgery. 2017 ; Vol. 104. pp. 687-693.
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title = "Gamma Knife Radiosurgery for Idiopathic Trigeminal Neuralgia: Does the Status of Offending Vessels Influence Pain Control or Side Effects?",
abstract = "Objective To evaluate pain control and side effects after gamma knife radiosurgery (GKRS) for classical idiopathic trigeminal neuralgia (TN) with or without neurovascular compression (NVC). Methods This study included 47 patients with type 1 idiopathic TN and Barrow Neurological Institute (BNI) pain class IV or V who were treated with GKRS, with a maximum dose of 85 Gy targeting the root entry zone, as an initial treatment modality between January 2005 and March 2015. A retrospective analysis of NVC status, pain control, side effects, recurrence, and cross-sectional area was conducted. Results During follow-up (median, 21.5 months; range, 3–119 months), 36 of the 47 patients (76.6{\%}) demonstrated good outcomes (i.e., improved to below BNI class IIIa). Twenty-two patients did not have NVC (group A) and 25 had NVC (group B). The rate of good outcomes did not differ significantly between the 2 groups (group A, 86.4{\%} [19 of 22] vs. group B, 68{\%} [17 of 25]; P = 0.138). The number of cases in BNI class I or II and the number of recurrences also did not differ significantly between the 2 groups (P = 0.532 and 0.786, respectively). The mean area was 8.64 ± 2.59 mm3 in nondeviated cases (n = 27) and 2.59 ± 1.68 mm3 in deviated (n = 10). Side effects were significantly more frequent in deviated cases (80{\%} [8 of 10]) than in nondeviated cases (25.9{\%} [7 of 27]; P = 0.003). Conclusions NVC is not a predictive factor for pain control after GKRS for the treatment of idiopathic TN. Side effects may occur more frequently in patients with NVC at the target coordinate when a root entry zone is used, but the subjective symptoms are not always bothersome.",
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Gamma Knife Radiosurgery for Idiopathic Trigeminal Neuralgia : Does the Status of Offending Vessels Influence Pain Control or Side Effects? / Jung, Hyun Ho; Park, Chang Kyu; Jung, Na Young; Kim, Minsoo; Chang, Won Seok; Chang, Jin Woo.

In: World Neurosurgery, Vol. 104, 08.2017, p. 687-693.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Gamma Knife Radiosurgery for Idiopathic Trigeminal Neuralgia

T2 - Does the Status of Offending Vessels Influence Pain Control or Side Effects?

AU - Jung, Hyun Ho

AU - Park, Chang Kyu

AU - Jung, Na Young

AU - Kim, Minsoo

AU - Chang, Won Seok

AU - Chang, Jin Woo

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N2 - Objective To evaluate pain control and side effects after gamma knife radiosurgery (GKRS) for classical idiopathic trigeminal neuralgia (TN) with or without neurovascular compression (NVC). Methods This study included 47 patients with type 1 idiopathic TN and Barrow Neurological Institute (BNI) pain class IV or V who were treated with GKRS, with a maximum dose of 85 Gy targeting the root entry zone, as an initial treatment modality between January 2005 and March 2015. A retrospective analysis of NVC status, pain control, side effects, recurrence, and cross-sectional area was conducted. Results During follow-up (median, 21.5 months; range, 3–119 months), 36 of the 47 patients (76.6%) demonstrated good outcomes (i.e., improved to below BNI class IIIa). Twenty-two patients did not have NVC (group A) and 25 had NVC (group B). The rate of good outcomes did not differ significantly between the 2 groups (group A, 86.4% [19 of 22] vs. group B, 68% [17 of 25]; P = 0.138). The number of cases in BNI class I or II and the number of recurrences also did not differ significantly between the 2 groups (P = 0.532 and 0.786, respectively). The mean area was 8.64 ± 2.59 mm3 in nondeviated cases (n = 27) and 2.59 ± 1.68 mm3 in deviated (n = 10). Side effects were significantly more frequent in deviated cases (80% [8 of 10]) than in nondeviated cases (25.9% [7 of 27]; P = 0.003). Conclusions NVC is not a predictive factor for pain control after GKRS for the treatment of idiopathic TN. Side effects may occur more frequently in patients with NVC at the target coordinate when a root entry zone is used, but the subjective symptoms are not always bothersome.

AB - Objective To evaluate pain control and side effects after gamma knife radiosurgery (GKRS) for classical idiopathic trigeminal neuralgia (TN) with or without neurovascular compression (NVC). Methods This study included 47 patients with type 1 idiopathic TN and Barrow Neurological Institute (BNI) pain class IV or V who were treated with GKRS, with a maximum dose of 85 Gy targeting the root entry zone, as an initial treatment modality between January 2005 and March 2015. A retrospective analysis of NVC status, pain control, side effects, recurrence, and cross-sectional area was conducted. Results During follow-up (median, 21.5 months; range, 3–119 months), 36 of the 47 patients (76.6%) demonstrated good outcomes (i.e., improved to below BNI class IIIa). Twenty-two patients did not have NVC (group A) and 25 had NVC (group B). The rate of good outcomes did not differ significantly between the 2 groups (group A, 86.4% [19 of 22] vs. group B, 68% [17 of 25]; P = 0.138). The number of cases in BNI class I or II and the number of recurrences also did not differ significantly between the 2 groups (P = 0.532 and 0.786, respectively). The mean area was 8.64 ± 2.59 mm3 in nondeviated cases (n = 27) and 2.59 ± 1.68 mm3 in deviated (n = 10). Side effects were significantly more frequent in deviated cases (80% [8 of 10]) than in nondeviated cases (25.9% [7 of 27]; P = 0.003). Conclusions NVC is not a predictive factor for pain control after GKRS for the treatment of idiopathic TN. Side effects may occur more frequently in patients with NVC at the target coordinate when a root entry zone is used, but the subjective symptoms are not always bothersome.

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