Predictive variables for the successful treatment of trigeminal neuralgia with gamma knife radiosurgery.

Kopriva Marshall, Michael D. Chan, Thomas P. McCoy, Adam C. Aubuchon, J. Daniel Bourland, Kevin P. McMullen, Allan F. deGuzman, Michael T. Munley, Edward G. Shaw, Stephen B. Tatter, Thomas L. Ellis

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Gamma Knife radiosurgery (GKRS) has been reported to be an effective modality to treat trigeminal neuralgia. To determine predictive factors for the successful treatment of trigeminal neuralgia with GKRS. Between 1999 and 2008, 777 GKRS procedures for patients with trigeminal neuralgia were performed at our institution. Evaluable follow-up data were obtained for 448 patients. Median follow-up time was 20.9 months (range, 3-86 months). The mean maximum prescribed dose was 88 Gy (range, 80-97 Gy). Dosimetric variables recorded included dorsal root entry zone dose, pons maximum dose, dose to the petrous dural ridge, and cisternal nerve length. By 3 months after GKRS, 86% of patients achieved Barrow Neurologic Institute I to III pain scores, with 43% of patients achieving a Barrow Neurologic Institute I pain score. Twenty-six percent of patients reported posttreatment facial numbness; 28% of patients reported a post-GKRS procedure for relapsed pain, and median time to next procedure was 4.4 years. Multivariate analysis revealed that the development of postsurgical numbness (odds ratio [OR], 2.76; P = .006) was the dominant factor predictive of efficacy. Longer cisternal nerve length (OR, 0.85; P = .005), prior radiofrequency ablation (OR, 0.35; P = .028), and diabetes mellitus (OR, 0.38; P = .013) predicted decreased efficacy. The mean dose delivered to the dorsal root entry zone dose in patients who developed facial numbness (57.6 Gy) was more than the mean dose (47.3 Gy) given to patients who did not develop numbness (P = .02). The development of post-GKRS facial numbness is a dominant factor that predicts for efficacy of GKRS. History of diabetes mellitus or previous radiofrequency ablation may portend worsened outcome.

Original languageEnglish (US)
JournalNeurosurgery
Volume70
Issue number3
StatePublished - Mar 2012
Externally publishedYes

Fingerprint

Trigeminal Neuralgia
Radiosurgery
Hypesthesia
Odds Ratio
Spinal Nerve Roots
Therapeutics
Pain
Nervous System
Diabetes Mellitus
Pons
Multivariate Analysis

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Marshall, K., Chan, M. D., McCoy, T. P., Aubuchon, A. C., Bourland, J. D., McMullen, K. P., ... Ellis, T. L. (2012). Predictive variables for the successful treatment of trigeminal neuralgia with gamma knife radiosurgery. Neurosurgery, 70(3).

Predictive variables for the successful treatment of trigeminal neuralgia with gamma knife radiosurgery. / Marshall, Kopriva; Chan, Michael D.; McCoy, Thomas P.; Aubuchon, Adam C.; Bourland, J. Daniel; McMullen, Kevin P.; deGuzman, Allan F.; Munley, Michael T.; Shaw, Edward G.; Tatter, Stephen B.; Ellis, Thomas L.

In: Neurosurgery, Vol. 70, No. 3, 03.2012.

Research output: Contribution to journalArticle

Marshall, K, Chan, MD, McCoy, TP, Aubuchon, AC, Bourland, JD, McMullen, KP, deGuzman, AF, Munley, MT, Shaw, EG, Tatter, SB & Ellis, TL 2012, 'Predictive variables for the successful treatment of trigeminal neuralgia with gamma knife radiosurgery.', Neurosurgery, vol. 70, no. 3.
Marshall K, Chan MD, McCoy TP, Aubuchon AC, Bourland JD, McMullen KP et al. Predictive variables for the successful treatment of trigeminal neuralgia with gamma knife radiosurgery. Neurosurgery. 2012 Mar;70(3).
Marshall, Kopriva ; Chan, Michael D. ; McCoy, Thomas P. ; Aubuchon, Adam C. ; Bourland, J. Daniel ; McMullen, Kevin P. ; deGuzman, Allan F. ; Munley, Michael T. ; Shaw, Edward G. ; Tatter, Stephen B. ; Ellis, Thomas L. / Predictive variables for the successful treatment of trigeminal neuralgia with gamma knife radiosurgery. In: Neurosurgery. 2012 ; Vol. 70, No. 3.
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abstract = "Gamma Knife radiosurgery (GKRS) has been reported to be an effective modality to treat trigeminal neuralgia. To determine predictive factors for the successful treatment of trigeminal neuralgia with GKRS. Between 1999 and 2008, 777 GKRS procedures for patients with trigeminal neuralgia were performed at our institution. Evaluable follow-up data were obtained for 448 patients. Median follow-up time was 20.9 months (range, 3-86 months). The mean maximum prescribed dose was 88 Gy (range, 80-97 Gy). Dosimetric variables recorded included dorsal root entry zone dose, pons maximum dose, dose to the petrous dural ridge, and cisternal nerve length. By 3 months after GKRS, 86{\%} of patients achieved Barrow Neurologic Institute I to III pain scores, with 43{\%} of patients achieving a Barrow Neurologic Institute I pain score. Twenty-six percent of patients reported posttreatment facial numbness; 28{\%} of patients reported a post-GKRS procedure for relapsed pain, and median time to next procedure was 4.4 years. Multivariate analysis revealed that the development of postsurgical numbness (odds ratio [OR], 2.76; P = .006) was the dominant factor predictive of efficacy. Longer cisternal nerve length (OR, 0.85; P = .005), prior radiofrequency ablation (OR, 0.35; P = .028), and diabetes mellitus (OR, 0.38; P = .013) predicted decreased efficacy. The mean dose delivered to the dorsal root entry zone dose in patients who developed facial numbness (57.6 Gy) was more than the mean dose (47.3 Gy) given to patients who did not develop numbness (P = .02). The development of post-GKRS facial numbness is a dominant factor that predicts for efficacy of GKRS. History of diabetes mellitus or previous radiofrequency ablation may portend worsened outcome.",
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