Treatment Of Trigeminal Neuralgia Secondary To Compression By Acoustic Neuroma And Meningioma Using Gamma Knife Surgery

Keywords: trigeminal neuralgia, meningioma, vestibular schwannoma, pain, gamma knife

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     The authors report the effects of Gamma Knife Surgery (GKS) on two cases of trigeminal neuralgia imbedded in acoustic neuroma and meningioma.
     The first patient was 82 years old male with uncontrolled left sided trigeminal neuralgia for 6 years and a left sided acoustic neuroma with ipsilateral hearing loss. The second patient was 62 years old female with right sided trigeminal neuralgia and a meningioma abutting and involving the trigeminal nerve.
     First patient: The treatment volume of acoustic neuroma was 4.5 cm3. Second Patient: The volume of meningioma was 0.33 cm3. Both patients underwent GKS using Gamma Knife Perfexion system. Two matrixes were set up to accommodate two distinct dose prescriptions. The marginal dose to the acoustic neuroma and meningioma was 13 Gy (50% isodose). The ipsilateral trigeminal nerve was given a maximal dose of 85 Gy (100% isodose).
     Both patients experienced remarkable pain relief in 6 month follow up. No treatment related sequelae was observed. MRI scans three months post treatment demonstrated interval regression of tumor sizes.
     This is a retrospective study.
     Gamma Knife Surgery using Gamma Knife Perfexion system was able to achieve significantly diverse therapeutic doses to two targets within the same volume.
     Clinically significant improvement of symptomatology was accomplished. Longer follow up is needed to assess the long term benefits and risks.


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