Trigeminal neuralgia treatment outcomes following Gamma Knife radiosurgery with a minimum 3-year follow-up.

Autor: Karam SD; Department of Radiation Oncology, Medstar Georgetown University Hospital, 3800 Reservoir Rd., NW, Washington, DC 20007 USA., Tai A; Department of Radiation Oncology, Medstar Georgetown University Hospital, 3800 Reservoir Rd., NW, Washington, DC 20007 USA., Wooster M; Department of Radiation Oncology, Medstar Georgetown University Hospital, 3800 Reservoir Rd., NW, Washington, DC 20007 USA., Rashid A; Department of Radiation Oncology, Medstar Georgetown University Hospital, 3800 Reservoir Rd., NW, Washington, DC 20007 USA., Chen R; Department of Radiation Oncology, Medstar Washington Hospital Center, Washington, DC USA., Baig N; Department of Radiation Oncology, Medstar Georgetown University Hospital, 3800 Reservoir Rd., NW, Washington, DC 20007 USA., Jay A; Department of Radiology, Medstar Georgetown University Hospital, Washington, DC USA., Harter KW; Department of Radiation Oncology, Medstar Georgetown University Hospital, 3800 Reservoir Rd., NW, Washington, DC 20007 USA., Randolph-Jackson P; Department of Radiation Oncology, Medstar Washington Hospital Center, Washington, DC USA., Omogbehin A; Department of Radiation Oncology, Medstar Washington Hospital Center, Washington, DC USA., Aulisi EF; Department of Neurosurgery, Medstar Washington Hospital Center, Washington, DC USA., Jacobson J; Department of Neurosurgery, Medstar Washington Hospital Center, Washington, DC USA.
Jazyk: angličtina
Zdroj: Journal of radiation oncology [J Radiat Oncol] 2014; Vol. 3, pp. 125-130. Date of Electronic Publication: 2013 Nov 20.
DOI: 10.1007/s13566-013-0134-3
Abstrakt: Objective: Effective short-term outcomes have been well documented for trigeminal neuralgia (TN) patients treated with Gamma Knife radiosurgery (GKRS) with reported success rates of 70-90 % with median follow-up intervals of 19-75 months. Fewer series, however, have described uniform long-term follow-up data. In this study, we report our long-term institutional outcomes in patients treated with GKRS after a minimum follow-up of 36 months.
Methods: Thirty-six consecutive patients with medically intractable TN received a median radiation dose of 45 Gy applied with a single 4-mm isocenter to the affected trigeminal nerve. Follow-up data were obtained by clinical examination and telephone questionnaire. Outcome results were categorized based on the Barrow Neurological Institute (BNI) pain scale with BNI I-III considered to be good outcomes and BNI IV-V considered as treatment failure. BNI facial numbness score was used to assess treatment complications.
Results: The incidence of early pain relief was high (80.5 %) and relief was noted in an average of 1.6 months after treatment. At minimum follow-up of 3 years, 67 % were pain free (BNI I) and 75 % had good treatment outcome. At a mean last follow-up of 69 months, 32 % were free from any pain and 63 % were free from severe pain. Bothersome posttreatment facial numbness was reported in 11 % of the patients. A statistically significant correlation was found between age and recurrence of any pain with age >70 predicting a more favorable outcome after radiosurgery.
Conclusion: The success rate of GKRS for treatment of medically intractable TN declines over time with 32 % reporting ideal outcome and 63 % reporting good outcome. Patients older than age 70 are good candidates for radiosurgery. This data should help in setting realistic expectations for weighing the various available treatment options.
Databáze: MEDLINE
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