Does increased nerve length within the treatment volume improve trigeminal neuralgia radiosurgery?. A prospective double-blind, randomized study

John C. Flickinger, Bruce E. Pollock, Douglas Kondziolka, Loi K. Phuong, Robert L. Foote, Scott L. Stafford, L. Dade Lunsford

Research output: Contribution to journalArticle

122 Citations (Scopus)

Abstract

Purpose: To test the hypothesis that increasing the nerve length within the treatment volume for trigeminal neuralgia radiosurgery would improve pain relief. Methods and Materials: Eighty-seven patients with typical trigeminal neuralgia were randomized to undergo retrogasserian gamma knife radiosurgery (75 Gy maximal dose with 4-mm diameter collimators) using either one (n = 44) or two (n = 43) isocenters. The median follow-up was 26 months (range 1-36). Results: Pain relief was complete in 57 patients (45 without medication and 12 with low-dose medication), partial in 15, and minimal in another 15 patients. The actuarial rate of obtaining complete pain relief (with or without medication) was 67.7% ± 5.1%. The pain relief was identical for one- and two-isocenter radiosurgery. Pain relapsed in 30 of 72 responding patients. Facial numbness and mild and severe paresthesias developed in 8, 5, and 1 two-isocenter patients vs. 3, 4, and 0 one-isocenter patients, respectively (p = 0.23). Improved pain relief correlated with younger age (p = 0.025) and fewer prior procedures (p = 0.039) and complications (numbness or paresthesias) correlated with the nerve length irradiated (p = 0.018). Conclusions: Increasing the treatment volume to include a longer nerve length for trigeminal neuralgia radiosurgery does not significantly improve pain relief but may increase complications.

Original languageEnglish (US)
Pages (from-to)449-454
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume51
Issue number2
DOIs
StatePublished - Oct 1 2001

Fingerprint

Trigeminal Neuralgia
pain
Radiosurgery
nerves
Double-Blind Method
Pain
Hypesthesia
Paresthesia
Therapeutics
dosage
collimators

Keywords

  • Pain
  • Radiosurgery
  • Stereotactic
  • Trigeminal neuralgia

ASJC Scopus subject areas

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

Cite this

Does increased nerve length within the treatment volume improve trigeminal neuralgia radiosurgery?. A prospective double-blind, randomized study. / Flickinger, John C.; Pollock, Bruce E.; Kondziolka, Douglas; Phuong, Loi K.; Foote, Robert L.; Stafford, Scott L.; Lunsford, L. Dade.

In: International Journal of Radiation Oncology Biology Physics, Vol. 51, No. 2, 01.10.2001, p. 449-454.

Research output: Contribution to journalArticle

Flickinger, John C. ; Pollock, Bruce E. ; Kondziolka, Douglas ; Phuong, Loi K. ; Foote, Robert L. ; Stafford, Scott L. ; Lunsford, L. Dade. / Does increased nerve length within the treatment volume improve trigeminal neuralgia radiosurgery?. A prospective double-blind, randomized study. In: International Journal of Radiation Oncology Biology Physics. 2001 ; Vol. 51, No. 2. pp. 449-454.
@article{54ee8afa70b848ddbcc15f491e0d80e0,
title = "Does increased nerve length within the treatment volume improve trigeminal neuralgia radiosurgery?. A prospective double-blind, randomized study",
abstract = "Purpose: To test the hypothesis that increasing the nerve length within the treatment volume for trigeminal neuralgia radiosurgery would improve pain relief. Methods and Materials: Eighty-seven patients with typical trigeminal neuralgia were randomized to undergo retrogasserian gamma knife radiosurgery (75 Gy maximal dose with 4-mm diameter collimators) using either one (n = 44) or two (n = 43) isocenters. The median follow-up was 26 months (range 1-36). Results: Pain relief was complete in 57 patients (45 without medication and 12 with low-dose medication), partial in 15, and minimal in another 15 patients. The actuarial rate of obtaining complete pain relief (with or without medication) was 67.7{\%} ± 5.1{\%}. The pain relief was identical for one- and two-isocenter radiosurgery. Pain relapsed in 30 of 72 responding patients. Facial numbness and mild and severe paresthesias developed in 8, 5, and 1 two-isocenter patients vs. 3, 4, and 0 one-isocenter patients, respectively (p = 0.23). Improved pain relief correlated with younger age (p = 0.025) and fewer prior procedures (p = 0.039) and complications (numbness or paresthesias) correlated with the nerve length irradiated (p = 0.018). Conclusions: Increasing the treatment volume to include a longer nerve length for trigeminal neuralgia radiosurgery does not significantly improve pain relief but may increase complications.",
keywords = "Pain, Radiosurgery, Stereotactic, Trigeminal neuralgia",
author = "Flickinger, {John C.} and Pollock, {Bruce E.} and Douglas Kondziolka and Phuong, {Loi K.} and Foote, {Robert L.} and Stafford, {Scott L.} and Lunsford, {L. Dade}",
year = "2001",
month = "10",
day = "1",
doi = "10.1016/S0360-3016(01)01606-6",
language = "English (US)",
volume = "51",
pages = "449--454",
journal = "International Journal of Radiation Oncology Biology Physics",
issn = "0360-3016",
publisher = "Elsevier Inc.",
number = "2",

}

TY - JOUR

T1 - Does increased nerve length within the treatment volume improve trigeminal neuralgia radiosurgery?. A prospective double-blind, randomized study

AU - Flickinger, John C.

AU - Pollock, Bruce E.

AU - Kondziolka, Douglas

AU - Phuong, Loi K.

AU - Foote, Robert L.

AU - Stafford, Scott L.

AU - Lunsford, L. Dade

PY - 2001/10/1

Y1 - 2001/10/1

N2 - Purpose: To test the hypothesis that increasing the nerve length within the treatment volume for trigeminal neuralgia radiosurgery would improve pain relief. Methods and Materials: Eighty-seven patients with typical trigeminal neuralgia were randomized to undergo retrogasserian gamma knife radiosurgery (75 Gy maximal dose with 4-mm diameter collimators) using either one (n = 44) or two (n = 43) isocenters. The median follow-up was 26 months (range 1-36). Results: Pain relief was complete in 57 patients (45 without medication and 12 with low-dose medication), partial in 15, and minimal in another 15 patients. The actuarial rate of obtaining complete pain relief (with or without medication) was 67.7% ± 5.1%. The pain relief was identical for one- and two-isocenter radiosurgery. Pain relapsed in 30 of 72 responding patients. Facial numbness and mild and severe paresthesias developed in 8, 5, and 1 two-isocenter patients vs. 3, 4, and 0 one-isocenter patients, respectively (p = 0.23). Improved pain relief correlated with younger age (p = 0.025) and fewer prior procedures (p = 0.039) and complications (numbness or paresthesias) correlated with the nerve length irradiated (p = 0.018). Conclusions: Increasing the treatment volume to include a longer nerve length for trigeminal neuralgia radiosurgery does not significantly improve pain relief but may increase complications.

AB - Purpose: To test the hypothesis that increasing the nerve length within the treatment volume for trigeminal neuralgia radiosurgery would improve pain relief. Methods and Materials: Eighty-seven patients with typical trigeminal neuralgia were randomized to undergo retrogasserian gamma knife radiosurgery (75 Gy maximal dose with 4-mm diameter collimators) using either one (n = 44) or two (n = 43) isocenters. The median follow-up was 26 months (range 1-36). Results: Pain relief was complete in 57 patients (45 without medication and 12 with low-dose medication), partial in 15, and minimal in another 15 patients. The actuarial rate of obtaining complete pain relief (with or without medication) was 67.7% ± 5.1%. The pain relief was identical for one- and two-isocenter radiosurgery. Pain relapsed in 30 of 72 responding patients. Facial numbness and mild and severe paresthesias developed in 8, 5, and 1 two-isocenter patients vs. 3, 4, and 0 one-isocenter patients, respectively (p = 0.23). Improved pain relief correlated with younger age (p = 0.025) and fewer prior procedures (p = 0.039) and complications (numbness or paresthesias) correlated with the nerve length irradiated (p = 0.018). Conclusions: Increasing the treatment volume to include a longer nerve length for trigeminal neuralgia radiosurgery does not significantly improve pain relief but may increase complications.

KW - Pain

KW - Radiosurgery

KW - Stereotactic

KW - Trigeminal neuralgia

UR - http://www.scopus.com/inward/record.url?scp=0035479091&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035479091&partnerID=8YFLogxK

U2 - 10.1016/S0360-3016(01)01606-6

DO - 10.1016/S0360-3016(01)01606-6

M3 - Article

C2 - 11567820

AN - SCOPUS:0035479091

VL - 51

SP - 449

EP - 454

JO - International Journal of Radiation Oncology Biology Physics

JF - International Journal of Radiation Oncology Biology Physics

SN - 0360-3016

IS - 2

ER -