Gamma Knife Radiosurgery For Cluster Headache: Report Of The North American Gamma Knife Consortium

Keywords: headache, gamma knife, cluster headache, pain, outcome

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     The purpose of this study was to assess the outcomes of Gamma Knife stereotactic radiosurgery (SRS) when used for patients with intractable medically resistant cluster headache.
     Four participating centers of the North American Gamma Knife Consortium (NAGKC) identified 17 patients who underwent SRS for intractable cluster headache between 1996 and 2008. The median patient age was 47 years (range, 26-83 years). The median duration of symptoms before SRS was ten years (range, 1.3-40 years). Seven patients had unsuccessful prior surgical procedures.
     The radiosurgical target was the trigeminal nerve (TN) root and the sphenopalatine ganglion (SPG) (n=8), trigeminal nerve alone (n=8) and SPG alone (n=1). The median maximum TN and SPG dose was 80 Gy. Fourteen patients (82%) had typical autonomic features at the time of pain attacks
     Favorable pain relief (Barrow Neurological Institute Grades I-IIIb) was achieved and maintained in ten of 17 patients (59%) at a median follow-up of 34 months. Two patients required additional procedures (repeat SRS, n=1; hypothalamic DBS, n=1). Six (43%) of 14 patients who had autonomic features had improvement in their autonomic features after SRS. Eight of 16 patients (50%) who had their trigeminal nerve irradiated developed facial sensory dysfunction after SRS.
     This is a retrospective study.
     SRS for intractable, medically refractory cluster headache provided lasting pain reduction in approximately 60% of patients, but was associated with a significantly greater chance of facial sensory disturbances than SRS for trigeminal neuralgia.
     The NAGKC plans to proceed with a randomized prospective clinical trial to assess the value of adding the SPG target to the TN Target.


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