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

123 Scopus citations

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

Keywords

  • Pain
  • Radiosurgery
  • Stereotactic
  • Trigeminal neuralgia

ASJC Scopus subject areas

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

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