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• W2000862504 abstract "Purpose/Objective: Stereotactic radiosurgery has become an important and minimally invasive treatment modality for patients with refractory trigeminal neuralgia (TN). It is unclear, however, how best to manage patients with pain that is refractory or recurrent after initial radiosurgical treatment. Here we report on treatment outcomes and quality of life for patients treated with repeat radiosurgery for refractory or recurrent TN. Materials/Methods: Between June 1996 and June 2001, 112 patients with trigeminal neuralgia refractory to medical or surgical management were treated with Gamma Knife radiosurgery (GKRS) at the University of Maryland Medical Center. Eighteen patients underwent a second GKRS ranging 3 to 42 months (median, 8 months) after initial treatment because of unsatisfactory or unsustained pain relief. All retreated patients had failed medical management prior to GKRS and 3 patients (17%) had undergone previous surgical interventions. Median prescription doses for the first and second treatments of 75 and 70 Gy, respectively, were delivered to the involved trigeminal nerve root entry zone. Using a 32-plug blocking pattern the brainstem was irradiated at no greater than the 20% isodose line for any patient. Treatment outcomes were assessed through patient self-reports of pain control and medication usage during follow-up visits. In addition, patients responded to a standard questionnaire containing the complete Barrow Neurological Institute Pain Scale (BNI) and relevant sections of the McGill Pain Scale, conducted by a physician who was blinded to patient treatment characteristics. Treatment outcomes and objective quality of life measures were also addressed. Results: All patients were assessable at a median follow-up of 37.5 months (range: 12–68 months) following the first GKRS and 27.5 months (range: 6–65 months) after the second GKRS. Following initial GKRS, 9 patients (50%) had excellent responses, 5 patients (28%) had good responses, 1 patient (6%) had a fair response, and 3 patients (16%) had poor responses. After repeat GKRS, pain outcomes were excellent for 8 patients (45%), good for 6 patients (33%), and poor in 4 patients (22%). All 3 patients with poor responses following initial GKRS reported poor outcomes after repeat GKRS, as well. Among those with pain relief and subsequent recurrence after initial GKRS, 14 patients (93%) achieved excellent or good pain outcomes following repeat GKRS. Median time to response after repeat GKRS was 1 week (range: 0–36 weeks) with 6 patients (43%) experiencing immediate pain relief. In addition, a decrease in medication usage after repeat GKRS was noted in 61% of patients. Actuarial analysis revealed 1-year and 2-year recurrence rates of 21% and 29%, respectively. Patients with excellent or good pain outcomes following repeat GKRS reported a longer median period of pain relief after initial GKRS when compared with patients who responded poorly to repeat GKRS (12 months vs. 4 months, p=0.04). Two patients (11%) reported new or increased facial numbness after treatment, this was described as bothersome (BNI Class III or IV) by only 1 patient. Overall, patients reported an average of 60% improvement in their quality of life as a direct result of pain relief after repeat GKRS, and 56% of patients believed that the procedure was successful in their case. Furthermore, excluding patients who did not respond to initial GKRS, 71% felt their treatment was a success with an average 85% improvement in their quality of life. Conclusions: Despite modest dose reduction, repeat GKRS provided similar rates of complete pain control as the initial procedure. Repeat GKRS was not effective for patients who did not respond to initial treatment. Furthermore, repeat GKRS appears to be more efficacious for those patients who experienced longer periods of pain relief following initial GKRS. The incidence of complications, including facial numbness, was not significantly different from that observed for initial GKRS. In this series, the majority of patients appreciated significant improvements in quality of life and generally considered their repeat GKRS treatment successful." @default.
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• W2000862504 date "2003-10-01" @default.
• W2000862504 modified "2023-10-15" @default.
• W2000862504 title "Repeat gamma knife radiosurgery for refractory or recurrent trigeminal neuralgia" @default.
• W2000862504 doi "https://doi.org/10.1016/s0360-3016(03)00845-9" @default.
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