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Title: Repeat Gamma Knife Radiosurgery for Trigeminal Neuralgia

Abstract

Purpose: Repeat gamma knife stereotactic radiosurgery (GKRS) for recurrent or persistent trigeminal neuralgia induces an additional response but at the expense of an increased incidence of facial numbness. The present series summarized the results of a repeat treatment series at Wake Forest University Baptist Medical Center, including a multivariate analysis of the data to identify the prognostic factors for treatment success and toxicity. Methods and Materials: Between January 1999 and December 2007, 37 patients underwent a second GKRS application because of treatment failure after a first GKRS treatment. The mean initial dose in the series was 87.3 Gy (range, 80-90). The mean retreatment dose was 84.4 Gy (range, 60-90). The dosimetric variables recorded included the dorsal root entry zone dose, pons surface dose, and dose to the distal nerve. Results: Of the 37 patients, 81% achieved a >50% pain relief response to repeat GKRS, and 57% experienced some form of trigeminal dysfunction after repeat GKRS. Two patients (5%) experienced clinically significant toxicity: one with bothersome numbness and one with corneal dryness requiring tarsorraphy. A dorsal root entry zone dose at repeat treatment of >26.6 Gy predicted for treatment success (61% vs. 32%, p = .0716). A cumulative dorsal root entrymore » zone dose of >84.3 Gy (72% vs. 44%, p = .091) and a cumulative pons surface dose of >108.5 Gy (78% vs. 44%, p = .018) predicted for post-GKRS numbness. The presence of any post-GKRS numbness predicted for a >50% decrease in pain intensity (100% vs. 60%, p = .0015). Conclusion: Repeat GKRS is a viable treatment option for recurrent trigeminal neuralgia, although the patient assumes a greater risk of nerve dysfunction to achieve maximal pain relief.« less

Authors:
 [1];  [1];  [2];  [3]; ;  [4]; ; ; ; ; ;  [1]
  1. Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, NC (United States)
  2. Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (United States)
  3. Department of Radiation Oncology, University of Florida, Gainesville, FL (United States)
  4. Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, NC (United States)
Publication Date:
OSTI Identifier:
22054410
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 81; Journal Issue: 4; Other Information: Copyright (c) 2011 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; FAILURES; GY RANGE 10-100; HAZARDS; MULTIVARIATE ANALYSIS; NERVES; NERVOUS SYSTEM DISEASES; NEUROLOGY; PAIN; PATIENTS; RADIATION DOSES; RADIOTHERAPY; SURGERY; TOXICITY

Citation Formats

Aubuchon, Adam C., E-mail: acaubuchon@gmail.com, Chan, Michael D., Lovato, James F., Balamucki, Christopher J., Ellis, Thomas L., Tatter, Stephen B., McMullen, Kevin P., Munley, Michael T., Deguzman, Allan F., Ekstrand, Kenneth E., Bourland, J. Daniel, and Shaw, Edward G. Repeat Gamma Knife Radiosurgery for Trigeminal Neuralgia. United States: N. p., 2011. Web. doi:10.1016/J.IJROBP.2010.07.010.
Aubuchon, Adam C., E-mail: acaubuchon@gmail.com, Chan, Michael D., Lovato, James F., Balamucki, Christopher J., Ellis, Thomas L., Tatter, Stephen B., McMullen, Kevin P., Munley, Michael T., Deguzman, Allan F., Ekstrand, Kenneth E., Bourland, J. Daniel, & Shaw, Edward G. Repeat Gamma Knife Radiosurgery for Trigeminal Neuralgia. United States. doi:10.1016/J.IJROBP.2010.07.010.
Aubuchon, Adam C., E-mail: acaubuchon@gmail.com, Chan, Michael D., Lovato, James F., Balamucki, Christopher J., Ellis, Thomas L., Tatter, Stephen B., McMullen, Kevin P., Munley, Michael T., Deguzman, Allan F., Ekstrand, Kenneth E., Bourland, J. Daniel, and Shaw, Edward G. Tue . "Repeat Gamma Knife Radiosurgery for Trigeminal Neuralgia". United States. doi:10.1016/J.IJROBP.2010.07.010.
@article{osti_22054410,
title = {Repeat Gamma Knife Radiosurgery for Trigeminal Neuralgia},
author = {Aubuchon, Adam C., E-mail: acaubuchon@gmail.com and Chan, Michael D. and Lovato, James F. and Balamucki, Christopher J. and Ellis, Thomas L. and Tatter, Stephen B. and McMullen, Kevin P. and Munley, Michael T. and Deguzman, Allan F. and Ekstrand, Kenneth E. and Bourland, J. Daniel and Shaw, Edward G.},
abstractNote = {Purpose: Repeat gamma knife stereotactic radiosurgery (GKRS) for recurrent or persistent trigeminal neuralgia induces an additional response but at the expense of an increased incidence of facial numbness. The present series summarized the results of a repeat treatment series at Wake Forest University Baptist Medical Center, including a multivariate analysis of the data to identify the prognostic factors for treatment success and toxicity. Methods and Materials: Between January 1999 and December 2007, 37 patients underwent a second GKRS application because of treatment failure after a first GKRS treatment. The mean initial dose in the series was 87.3 Gy (range, 80-90). The mean retreatment dose was 84.4 Gy (range, 60-90). The dosimetric variables recorded included the dorsal root entry zone dose, pons surface dose, and dose to the distal nerve. Results: Of the 37 patients, 81% achieved a >50% pain relief response to repeat GKRS, and 57% experienced some form of trigeminal dysfunction after repeat GKRS. Two patients (5%) experienced clinically significant toxicity: one with bothersome numbness and one with corneal dryness requiring tarsorraphy. A dorsal root entry zone dose at repeat treatment of >26.6 Gy predicted for treatment success (61% vs. 32%, p = .0716). A cumulative dorsal root entry zone dose of >84.3 Gy (72% vs. 44%, p = .091) and a cumulative pons surface dose of >108.5 Gy (78% vs. 44%, p = .018) predicted for post-GKRS numbness. The presence of any post-GKRS numbness predicted for a >50% decrease in pain intensity (100% vs. 60%, p = .0015). Conclusion: Repeat GKRS is a viable treatment option for recurrent trigeminal neuralgia, although the patient assumes a greater risk of nerve dysfunction to achieve maximal pain relief.},
doi = {10.1016/J.IJROBP.2010.07.010},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 4,
volume = 81,
place = {United States},
year = {2011},
month = {11}
}