Article Review:   "Gamma Knife Surgery for Trigeminal Neuralgia:  Outcomes and Prognostic Factors"  Jason Sheehan, MD, PhD, Hung-Chuan Pan, MD, Matei Stroila, PhD, Ladislau Steiner, MD, PhD, Lars Leksell Center for Gamma Surgery, Department of Neurological Surgery, University of Virginia, Charlottesville, VA .  Click here to go to full Article.  Illustrations.  Table 1.  Table 2.  Table 3.  Table 4.

Review:

Patients:

  1. Number: 136 patients treated with Gamma Knife surgery

  2. Distribution: 66 males, 70 females

 

Surgery:

  1. 151 surgeries on 136 patients (1 patient had 3 procedures and 14 others had 2 procedures)

  2. Dosage of  50 to 90 Gy

 

Diagnosis:

  1. Trigeminal Neuralgia 122 patients

  2. Atypical facial pain 14 patients

 

Results:

  1. Most patients experienced their maximum symptom relief within the first 2 months following surgery.

  2. Pain free without medication

    1. 1 year: 47% (of 118 patients available for follow-up)

    2. 2 years: 45% (of 64 patients available for follow-up)

    3. 3 years: 34%  (of 39 patients available for follow-up)

  3. Not pain free but some improvement:

    1. 1 year: 90% (of 118 patients available for follow-up)

    2. 2 years: 77% (of 64 patients available for follow-up)

    3. 3 years: 70%  (of 39 patients available for follow-up)

  4. Pain free typical pain vs. atypical pain

    1. Typical pain: 46% (of 122 patients available for follow-up)

    2. Atypical pain:  29% (of 14 patients available for follow-up)

  5. Recurrence of relief after initial improvement

 

Complications:

1.        New post-operative numbness 9%

a.       Repeat Gamma surgery 29% (4 out of 14 patients)

b.       Only one Gamma surgery 7% (8 out of 122 patients)

2.       Patients with new or worsened numbness (26 patients)

a.       Mild (12 patients)

b.       Disturbing (10 patients)

c.       Severe (4 patients)

3.       Numbness more likely in patients with prior glycerol injection

a.       Patients with  prior glycerol injection 26% numbness (12 out of 46)

b.       Patients without prior glycerol injection 16% numbness (14 out of 90)

 

Conclusion:  The treatment of choice for trigeminal neuralgia remains microvascular decompression, although Gamma surgery offers a reasonable alternative for those ineligible ore unwilling to undergo more invasive procedures. 

 

Reviewed by Alana Greca, BSN, RN,

TNA Patient Representative

Updated 2-4-05