Characterizing The Utility Of Gamma Knife Radiosurgery In The Treatment Of Trigeminal Neuralgia

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

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     For the younger patient population (< 60), many alternative treatments such as microvascular decompression and percutaneous rhizotomy may be considered in the treatment of trigeminal neuralgia.
     The objective of this retrospective review was to characterize the effectiveness of GKS for pain control in this group.
     Data from 239 patients who were treated with GKS at MidMichigan Medical Center from 2003-2008 were analyzed.
     After treatment, each patient was administered an annual survey to rate the effectiveness of GKS on their pain level as well their post-treatment facial numbness. Key patient factors such as duration of pain, pain distribution, and the number and type of pre-treatments were also analyzed in conjunction with survey responses. Statistical comparisons between the older patient population (>60) and the younger patient population (<60) were performed with regard to the aforementioned variables using Chi-squared. To adjust for the effect of the time interval after GKS, we used a Generalized Estimating Equations (GEE) model.
     Statistical analysis showed that the probability of effectiveness of treatment for pain relief was significantly higher in the older population compared to the younger population (OR: 2.73, p<0.05). Analysis also showed that the probability of post-treatment numbness was lower in the older population (OR: 0.56, p=0.07). Further analysis of the survey responses showed that for the first three years after treatment, the younger population rated GKS to be just as effective for their pain relief as the older population. Follow-up after 3 years revealed that GKS was more effective for relieving pain in the older population (p<0.01). The percentage of patients requiring a second treatment was significantly different between the older group (18.82%) and the younger group (6.52%), p<0.05.
     This is a retrospective study.
     GKS should remain a mainstay in the treatment of trigeminal neuralgia in older patients, whose co-morbid conditions might provoke adverse events with other neurosurgical techniques.
     GKS does provide both short-term relief of pain as well as minimal numbness in younger patients as well. We consider that the results will provide more information to clinicians about the long-term outcomes of GKS and help further characterize the role of GKS in treating a younger patient population.


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