Repeat radiosurgery for idiopathic trigeminal neuralgia

Bruce E. Pollock, Robert L. Foote, Michael J. Link, Scott L. Stafford, Paul D. Brown, Paula J. Schomberg

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Purpose Although frequently performed, the efficacy and safety of repeat trigeminal neuralgia radiosurgery is not well described. Methods and materials Between August 1997 and December 2002, 19 patients (9 men, 10 women) underwent repeat trigeminal neuralgia radiosurgery. The median interval between procedures was 16 months. The median dose (based on an output factor of 0.87 for the 4-mm collimator) for repeat radiosurgery was 76.1 Gy; the median additive dose was 163.1 Gy. Outcomes were defined as excellent (no pain, no medications), good (no pain, reduced medications), fair (>50% pain reduction), and poor. Median follow-up was 24 months. Results Outcomes after repeat radiosurgery were excellent (n = 14, 74%), good (n = 1, 5%), fair (n = 3, 16%), and poor (n = 1, 5%). Two patients had recurrent pain at 7 and 22 months; 71% and 61% of patients had an excellent outcome at 1- and 2-years after radiosurgery, respectively. Eleven patients (58%) described facial parathesias (n = 3), numbness (n = 5) or dyesthesias (n = 3). Two patients (11%) developed corneal numbness. Nine of 11 patients (82%) with new trigeminal deficits had excellent outcomes at last follow-up compared with 3 of 8 patients (38%) with unchanged facial sensation (p = 0.07). Conclusions Repeat trigeminal neuralgia radiosurgery at the dosage described has better facial pain outcomes than primary radiosurgery. However, because the procedure is nonselective and the rate of bothersome numbness was relatively high (16%), dose reduction is recommended to reduce the morbidity of repeat trigeminal neuralgia radiosurgery.

Original languageEnglish (US)
Pages (from-to)192-195
Number of pages4
JournalInternational Journal of Radiation Oncology Biology Physics
Volume61
Issue number1
DOIs
StatePublished - Jan 2005

Fingerprint

Trigeminal Neuralgia
Radiosurgery
pain
Hypesthesia
dosage
Pain
Facial Pain
collimators
safety
intervals
Morbidity
Safety
output

Keywords

  • Radiosurgery
  • Trigeminal neuralgia

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Pollock, B. E., Foote, R. L., Link, M. J., Stafford, S. L., Brown, P. D., & Schomberg, P. J. (2005). Repeat radiosurgery for idiopathic trigeminal neuralgia. International Journal of Radiation Oncology Biology Physics, 61(1), 192-195. https://doi.org/10.1016/j.ijrobp.2004.03.019

Repeat radiosurgery for idiopathic trigeminal neuralgia. / Pollock, Bruce E.; Foote, Robert L.; Link, Michael J.; Stafford, Scott L.; Brown, Paul D.; Schomberg, Paula J.

In: International Journal of Radiation Oncology Biology Physics, Vol. 61, No. 1, 01.2005, p. 192-195.

Research output: Contribution to journalArticle

Pollock, BE, Foote, RL, Link, MJ, Stafford, SL, Brown, PD & Schomberg, PJ 2005, 'Repeat radiosurgery for idiopathic trigeminal neuralgia', International Journal of Radiation Oncology Biology Physics, vol. 61, no. 1, pp. 192-195. https://doi.org/10.1016/j.ijrobp.2004.03.019
Pollock, Bruce E. ; Foote, Robert L. ; Link, Michael J. ; Stafford, Scott L. ; Brown, Paul D. ; Schomberg, Paula J. / Repeat radiosurgery for idiopathic trigeminal neuralgia. In: International Journal of Radiation Oncology Biology Physics. 2005 ; Vol. 61, No. 1. pp. 192-195.
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abstract = "Purpose Although frequently performed, the efficacy and safety of repeat trigeminal neuralgia radiosurgery is not well described. Methods and materials Between August 1997 and December 2002, 19 patients (9 men, 10 women) underwent repeat trigeminal neuralgia radiosurgery. The median interval between procedures was 16 months. The median dose (based on an output factor of 0.87 for the 4-mm collimator) for repeat radiosurgery was 76.1 Gy; the median additive dose was 163.1 Gy. Outcomes were defined as excellent (no pain, no medications), good (no pain, reduced medications), fair (>50{\%} pain reduction), and poor. Median follow-up was 24 months. Results Outcomes after repeat radiosurgery were excellent (n = 14, 74{\%}), good (n = 1, 5{\%}), fair (n = 3, 16{\%}), and poor (n = 1, 5{\%}). Two patients had recurrent pain at 7 and 22 months; 71{\%} and 61{\%} of patients had an excellent outcome at 1- and 2-years after radiosurgery, respectively. Eleven patients (58{\%}) described facial parathesias (n = 3), numbness (n = 5) or dyesthesias (n = 3). Two patients (11{\%}) developed corneal numbness. Nine of 11 patients (82{\%}) with new trigeminal deficits had excellent outcomes at last follow-up compared with 3 of 8 patients (38{\%}) with unchanged facial sensation (p = 0.07). Conclusions Repeat trigeminal neuralgia radiosurgery at the dosage described has better facial pain outcomes than primary radiosurgery. However, because the procedure is nonselective and the rate of bothersome numbness was relatively high (16{\%}), dose reduction is recommended to reduce the morbidity of repeat trigeminal neuralgia radiosurgery.",
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AB - Purpose Although frequently performed, the efficacy and safety of repeat trigeminal neuralgia radiosurgery is not well described. Methods and materials Between August 1997 and December 2002, 19 patients (9 men, 10 women) underwent repeat trigeminal neuralgia radiosurgery. The median interval between procedures was 16 months. The median dose (based on an output factor of 0.87 for the 4-mm collimator) for repeat radiosurgery was 76.1 Gy; the median additive dose was 163.1 Gy. Outcomes were defined as excellent (no pain, no medications), good (no pain, reduced medications), fair (>50% pain reduction), and poor. Median follow-up was 24 months. Results Outcomes after repeat radiosurgery were excellent (n = 14, 74%), good (n = 1, 5%), fair (n = 3, 16%), and poor (n = 1, 5%). Two patients had recurrent pain at 7 and 22 months; 71% and 61% of patients had an excellent outcome at 1- and 2-years after radiosurgery, respectively. Eleven patients (58%) described facial parathesias (n = 3), numbness (n = 5) or dyesthesias (n = 3). Two patients (11%) developed corneal numbness. Nine of 11 patients (82%) with new trigeminal deficits had excellent outcomes at last follow-up compared with 3 of 8 patients (38%) with unchanged facial sensation (p = 0.07). Conclusions Repeat trigeminal neuralgia radiosurgery at the dosage described has better facial pain outcomes than primary radiosurgery. However, because the procedure is nonselective and the rate of bothersome numbness was relatively high (16%), dose reduction is recommended to reduce the morbidity of repeat trigeminal neuralgia radiosurgery.

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