Outcome Of Gamma Knife Radiosurgery On Trigeminal Neuralgia In Patients With Severe Medical Illness

Keywords: gamma knife, pain, trigeminal neuralgia, outcome, radiosurgery

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     Gamma knife radiosurgery is one of multiple disciplinary armamentariums in treating trigeminal neuralgia and regarded as the first choice in medically compromised patients.
     In this study, we investigated the efficacy of gamma knife radiosurgery on trigeminal neuralgia in severe medical illness patients.
     From May 2004 to September 2007, 52 patients with severe medical illness harboring trigeminal neuralgia with BNI scores 4 to5 were entered into this study.
     The medical records and imaging findings were randomly and blindly reviewed by anesthetists and neurosurgeons to approve the gamma knife as the optimal treatment. All patients received the same gamma knife treatment procedure with maximum dosage of 80 Gy targeted on trigeminal nerve either with or without plugging to keep brain stem less than 16 Gy. After treatment, every patient received clinical visit with the interval of 1-3 months and filled out the questionnaires consisting of BNI scores, visual analogue scores (VAS), and SF-36 at the interval of 3 months till the end of study. Generalized estimating equation was used for statistical analysis.
     The median age of patient was 71 with male to female ration of 30/22. The median follow up period was 54 months (at least 2 years). All patients had the initial response with BNI scores one point less than that in pre-treatment. Only three patients reached BNI score of I. Twenty three patients (44.2%) experienced the pain recurrence at the median follow up of 33 months. One patient suffered angina in need of ICU care and another one patient had profuse pin wound bleeding mandatory of surgical suture. In univariate and multivariate analysis, decreased BNI scores were significantly related to age (p=0.01) (p=0.04), previous treatment (p=0.003) (p=0.001), vessel compression (p=0.008) (p=0.001), VAS (p<0.001) (p<0.001), SF-36 (RF) (p<0.001) (p<0.001), SF-36 (RP)( p<0.001) (p<0.001), SF-36 (RE) ( p<0.001) (p<0.001), SF-36 (MH) (p<0.001) (p<0.001), SF-36 (SF) (p<0.001) (p<0.001), SF-36 (BP) ( p=0.01) ( p=0.04), and SF-36 ( GH) ( p<0.001) (p<0.001), but not related to SF-36 (VT) ( p=0.09).
     This is a retrospective study.
     Gamma knife radiosurgery produced significant pain relief in severe medical illness patients harboring trigeminal neuralgia without causing remarkable morbidity.
     The effect of reduced pain significantly paralleled the improvement of quality of life.


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