Repeat gamma knife radiosurgery for trigeminal neuralgia

Adam C. Aubuchon, Michael D. Chan, James F. Lovato, Christopher J. Balamucki, Thomas L. Ellis, Stephen B. Tatter, Kevin P. McMullen, Michael T. Munley, Allan F. Deguzman, Kenneth E. Ekstrand, J. Daniel Bourland, Edward G. Shaw

Research output: Contribution to journalArticle

25 Citations (Scopus)

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 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.

Original languageEnglish (US)
Pages (from-to)1059-1065
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume81
Issue number4
DOIs
StatePublished - Nov 15 2011
Externally publishedYes

Fingerprint

Trigeminal Neuralgia
Radiosurgery
dosage
pain
entry
Hypesthesia
nerves
toxicity
Spinal Nerve Roots
Pons
Pain
wakes
Therapeutics
incidence
Retreatment
Treatment Failure

Keywords

  • Gamma knife
  • Radiosurgery
  • Repeat
  • Toxicity
  • Trigeminal neuralgia

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Aubuchon, A. C., Chan, M. D., Lovato, J. F., Balamucki, C. J., Ellis, T. L., Tatter, S. B., ... Shaw, E. G. (2011). Repeat gamma knife radiosurgery for trigeminal neuralgia. International Journal of Radiation Oncology Biology Physics, 81(4), 1059-1065. https://doi.org/10.1016/j.ijrobp.2010.07.010

Repeat gamma knife radiosurgery for trigeminal neuralgia. / Aubuchon, Adam C.; 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.

In: International Journal of Radiation Oncology Biology Physics, Vol. 81, No. 4, 15.11.2011, p. 1059-1065.

Research output: Contribution to journalArticle

Aubuchon, AC, Chan, MD, Lovato, JF, Balamucki, CJ, Ellis, TL, Tatter, SB, McMullen, KP, Munley, MT, Deguzman, AF, Ekstrand, KE, Bourland, JD & Shaw, EG 2011, 'Repeat gamma knife radiosurgery for trigeminal neuralgia', International Journal of Radiation Oncology Biology Physics, vol. 81, no. 4, pp. 1059-1065. https://doi.org/10.1016/j.ijrobp.2010.07.010
Aubuchon AC, Chan MD, Lovato JF, Balamucki CJ, Ellis TL, Tatter SB et al. Repeat gamma knife radiosurgery for trigeminal neuralgia. International Journal of Radiation Oncology Biology Physics. 2011 Nov 15;81(4):1059-1065. https://doi.org/10.1016/j.ijrobp.2010.07.010
Aubuchon, Adam C. ; 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. In: International Journal of Radiation Oncology Biology Physics. 2011 ; Vol. 81, No. 4. pp. 1059-1065.
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AU - Ellis, Thomas L.

AU - Tatter, Stephen B.

AU - McMullen, Kevin P.

AU - Munley, Michael T.

AU - Deguzman, Allan F.

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KW - Gamma knife

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KW - Repeat

KW - Toxicity

KW - Trigeminal neuralgia

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