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This Article Figures Only Full Text Full Text (PDF) CME: Take the course for this article: Volume 73, Number 14, October 6, 2009 Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Zorro, O. Articles by Kondziolka, D. PubMed PubMed Citation Articles by Zorro, O. Articles by Kondziolka, D. Related Collections Trigeminal neuralgia Multiple sclerosis

Gamma knife radiosurgery for multiple sclerosis–related trigeminal neuralgia

From the Department of Neurological Surgery (O.Z., J.L.-P., H.K., L.D.L., D.K.), Department of Radiation Oncology (J.C.F.), and the Center for Image-Guided Neurosurgery (O.Z., J.L.-P., H.K., J.C.F., L.D.L., D.K.), University of Pittsburgh School of Medicine, PA.

Address correspondence and reprint requests to Dr. Douglas Kondziolka, Peter J. Jannetta Professor of Neurological Surgery, University of Pittsburgh, Suite B-400, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA 15213 kondziolkads{at}upmc.edu

Background: Surgical options for multiple sclerosis (MS) related to trigeminal neuralgia (TN), a severe and disabling pain disorder, include percutaneous rhizotomy, stereotactic radiosurgery, or microsurgical nerve section. Our goal was to evaluate clinical outcomes after gamma knife radiosurgery (GKRS) in patients with MS with TN.

Methods: We evaluated clinical outcomes in 37 patients with TN managed over a 12-year period. The maximum TN target dose varied between 70 and 90 Gy. Seventy-eight percent of patients had failed prior surgery. In 9, GKRS was the first procedure. Median follow-up was 56.7 months (range, 6–174). Pain relief was assessed in each patient by physicians who did not participate in the surgery.

Results: Eventual complete pain relief (BNI grade I) after GKRS and reasonable pain control (BNI grade I–IIIb) after GKRS were noted in 23 patients (62.1%) and 36 patients (97.3%) at some point in their course. Reasonable pain control (BNI grade I–IIIb) after GKRS was maintained in 82.6%, 73.9%, and 54.0% of patients after 1, 3, and 5 years. Fourteen patients (37.8%) underwent a second or a subsequent procedure for residual or recurrent pain. Eight patients underwent a second GKRS, 5 underwent percutaneous glycerol rhizotomy, and 1 underwent balloon microcompression. The complication rate after GKRS was 5.4% (new onset of nondisabling paresthesias). No patient developed dysesthesias.

Conclusions: Gamma knife radiosurgery is the most minimally invasive surgical technique for multiple sclerosis–related trigeminal neuralgia and has low morbidity. For this reason, gamma knife radiosurgery proved to be a satisfactory management strategy for multiple sclerosis–related trigeminal neuralgia.

Abbreviations: BNI = Barrow Neurological Institute; GKRS = gamma knife radiosurgery; MS = multiple sclerosis; TN = trigeminal neuralgia.

This study was funded by a grant (to H.K.) from the Osaka Medical Research Foundation for Incurable Diseases.

Disclosure: Author disclosures are provided at the end of the article.

Received March 12, 2009. Accepted in final form July 17, 2009.