Thursday, April 11, 2024

Gamma Knife Surgery For Trigeminal Neuralgia

The Gamma Knife Advantage

Trigeminal Neuralgia – Treatment with Gamma Knife Radiosurgery

The Gamma Knife is a totally noninvasive technology. That means we dont have to make any incisions in the patient, we can do this with local anesthetic, we can do this with the patient as an outpatient. And since trigeminal neuralgia is a condition that often affects the elderly or patients who have other medical risk factors for other types of surgery we need a technology like this that allows us to treat patients even if they are on anticoagulations, if theyve had other types of surgery or have heart or lung problems for example. Since this is done totally noninvasively and we dont have to make any incisions, we can get a benefit of pain relief over the course of a number of days or a few weeks without any kind of major surgical intervention.

Trigeminal Neuralgia Research And Outcomes Data

The lack of anatomic and pathophysiologic background knowledge of the mechanisms of pain makes management of pain by open or closed stereotactic techniques largely unsatisfactory.

Early results using Gamma surgery to produce thalamotomies for pain control were published by Steiner et. al. All of the 52 patients treated suffered from terminal cancer and were treated prior to the advent of CT or MRI. Pneumoencephalography was used to target the thalamic centrum medianum-parafasciculus . Good pain relief was obtained in 8 patients and moderate pain relief in 18. The patients had in general only temporary relief of pain. Of those with good pain relief, five died without recurrence of pain between 1 and 13 months after the procedure, and three had recurrence of pain at 3, 6 and 9 months. Doses between 100 and 250 Gy were tested. Observation of an actual lesion was only possible in 21 of 36 patients that had a post-mortem examination. Not surprisingly, the presence of a lesion was associated with relief. Lesions were only reliably created with doses greater than 160 Gy. The collimators used were 3 by 5 and 3 by 7 mm. The most effective lesions were more medially located near the wall of the third ventricle, and the greatest relief was for face or arm pain.

Recovery From Gamma Knife Treatment

Following Gamma Knife treatment, the head frame will be removed and dressing may be applied. The patient will then be transported to the hospital for a few hours of observation. During that time, the local anesthetic will wear off and the patient may experience a headache. We recommend the patient receive medication for headache shortly after arriving to the hospital floor. Prior to discharge, we want to make sure that the patient is relatively comfortable and able to tolerate food without nausea.

Typically, the total hospital stay lasts approximately eight to 10 hours. On occasion and based on the physicians orders, a patient may be admitted for an overnight stay.

Learn more about recovery from Gamma Knife radiosurgery in this video featuring an experienced Gamma Knife nurse.

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How Gamma Knife Radiosurgery Works

With Gamma Knife surgery, a multidisciplinary team, uses computer imagery to direct a precisely focused beam of high-dose radiation to the trigeminal nerve. This causes a lesion to form on the nerve, which eventually disrupts the transmission of pain signals to the brain.

Pain relief after Gamma Knife surgery occurs gradually. If pain is not controlled, the procedure can be repeated.

only partial facial weaknesstotal hypesthesiatotal loss of sensationprevious treatments

  • Open microvascular decompression

Research1 indicates that as many as 96 % of trigeminal neuralgia patients experience pain relief within a few weeks after their Gamma Knife procedure. Just2 over 90 % of patients will not need another surgery within the first year. This does drop to 67.7 % at 10 years and remains at this level until 14 years.

The majority of the patients say that their quality of life improved after Gamma Knife radiosurgery and that the hypesthesia or loss of sensation on the face, when present, was a good trade-off for pain relief.

One in two patients will still need some medication to manage any pain but the doses are much lower and manageable.

Research has shown that following Gamma Knife radiosurgery:

  • 93.8 % of patients were pain free with or without medication
  • No patients developed an early complication.

Q: What About Facial Numbness

Gamma Knife Surgery in Trigeminal Neuralgia

A: In Dr. Regis’s study of 497 patients who underwent cisternal targeting of the trigeminal nerve, 20.4 percent experienced facial numbness at 5 years, while “somewhat or very bothersome” facial numbness was experienced in only 2.2 percent. By comparison, facial numbness occurs in less than 5 percent of patients who are treated with MVD. Numbness is the desired outcome in PSR, and it is achieved in virtually 100 percent of patients who undergo this treatment.

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Type 2 Trigeminal Neuralgia

Type 2 trigeminal neuralgia is a little less common. In addition to the intense, short bouts of sharp pain like that of Type 1, patients experience a more constant form of pain and discomfort.

  • A constant burning or aching, sometimes accompanied by a stabbing and/or shock-like pain
  • The pain and discomfort can be felt in the eyes, forehead, scalp, nose, lips, and upper and lower jaw
  • Much like Type 1, this form of trigeminal neuralgia can be triggered by sounds, touch or other normal activities
  • Occasionally, Type 1 symptoms with short, intermittent bouts will become less intense but be replaced by a constant burning or aching pain

What Are The Benefits Of The Gamma Knife Procedure Compare With Traditional Surgery

There are many benefits of Gamma Knife surgery over traditional surgery. Gamma Knife surgery:

  • Doesnt require incisions or general anesthesia.
  • Can target tumors/lesions deep in the brain that cant be safely reached by traditional surgery.
  • Can target multiple tumors/lesions at the same time.
  • Avoids other risks and complications of surgery .
  • Limits damage to the surrounding healthy tissue.
  • Results in little to no post-treatment discomfort or pain.
  • Is usually performed as an outpatient procedure .
  • Allows return to usual activities in a day or two.
  • Usually doesnt require physical therapy or other rehabilitation.

Its covered by most insurance and Medicare .

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Side Effects And Risks Of Gamma Knife Surgery For Trigeminal Neuralgia

Though Gamma Knife radiosurgery carries less risk than traditional surgery or radiation therapy, any medical procedure has potential side effects. Immediately following your treatment, you may feel a little nauseous or have a headache. If this occurs, your doctor can give you medications to help you feel more comfortable. Thats typically temporary and passes within a few days.

Some patients experience pain or swelling where the doctor positioned the frame on the scalp, which will subside within a few days. There could be a small amount of bleeding or itching as the pin sites heal. You may also feel fatigued during the first few days after your treatment, but this is usually far less severe than fatigue experienced following traditional radiation therapy. Sometimes swelling occurs approximately six months after your Gamma Knife radiosurgery. However, you can treat the swelling with medication, which your doctor will prescribe for you, if necessary. Your doctor will monitor you for any swelling at your follow-up appointments, so it is important you discuss any lingering or new symptoms you may be experiencing.

Gamma Knife Treatment For Trigeminal Neuralgia

Gamma Knife Perfexion Treatment for Trigeminal Neuralgia at LVHN

When medications and other types of treatment dont provide relief for the debilitating pain of trigeminal neuralgia, Gamma Knife treatment is an effective treatment option. During Gamma Knife stereotactic radiosurgery, surgeons disrupt the pain signals to the brain by targeting highly focused beams of radiation precisely at the trigeminal nerve root. Despite its name, Gamma Knife treatment is not a surgical procedure and is completely noninvasive. Gamma Knife treatment provides effective pain relief for 80 to 96 percent of trigeminal neuralgia patients, even five years after the procedure. It also can be repeated.

Learn more about Gamma Knife treatment for trigeminal neuralgia by our free guide.

Continue reading below to learn more about Gamma Knife treatment for trigeminal neuralgia. Or you can click on one of these topics to jump directly to the information that interests you.

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How Gamma Knife Treats Trigeminal Neuralgia

In Gamma Knife radiosurgery, a neurosurgeon uses computer imagery to direct a precisely focused beam of high-dose radiation to the root of the trigeminal nerve. This causes a lesion to form on the nerve, which eventually disrupts the transmission of pain signals to the brain. Pain relief occurs gradually.

Research indicates that as many as 96 percent of trigeminal neuralgia patients treated with Gamma Knife radiosurgery experience pain relief within a few weeks of the procedure. If pain recurs, the procedure can be repeated.

Because radiosurgery is the least invasive procedure for trigeminal neuralgia, it is often the best treatment option for patients with medical conditions that make traditional surgery risky.

Watch a video to learn more about Gamma Knife treatment for trigeminal neuralgia.

Comparison Of Microvascular Decompression And Two Isocenters Gamma Knife For The Treatment Of Trigeminal Neuralgia Caused By Vertebrobasilar Dolichoectasia

  • 1Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
  • 2Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China

Background: Vertebrobasilar dolichoectasia is one of the rare causes of trigeminal neuralgia . The common surgical treatments for patients with TN caused by VBD are microvascular decompression and Gamma Knife radiosurgery . However, the therapeutic effects of the two methods have not been clinically compared, so this study was performed to evaluate the treatment outcomes of MVD and GKRS for patients with VBD-TN.

Methods: The retrospective study was performed from March 2011 to March 2019 in Wuhan Union Hospital. A total of 80 patients diagnosed with VBD-TN were included in this study, and they were divided into the MVD group and GKRS group according to the surgical methods. The imaging data, intraoperative findings, treatment outcomes, and complications of the two groups were analyzed and compared. Meanwhile, the influencing factors of the treatment effect are also explored on the two groups.

MVD is superior to GKRS in obtaining and maintaining favorable outcomes for patients with VBD-TN, but it also comes with more complications other than facial numbness. Thus, the treatment program can be tailored to a patient’s unique condition and wishes.

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Discuss Your Case With Your Doctor

Though its helpful to understand what many patients experience, its impossible to predict what your Gamma Knife radiation recovery is going to be like. Your doctor is the person who knows your individual condition best, and he or she can discuss your expected treatment outcome. Part of the treatment-planning process involves weighing benefits and risks of all available options, including the side effects of Gamma Knife radiosurgery for trigeminal neuralgia.

As you move forward, continue to educate yourself about your condition and treatment options. Trigeminal neuralgia has historically been difficult to diagnose and manage, but doctors understand the condition better than ever. You have options, and many people have undergone treatment and seen relief from the pain. Be sure to continue the conversation with your doctor, so he or she can help answer any questions you have and set your mind at ease.

Gamma Knife Is Not Recommended For Trigeminal Neuralgia

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Trigeminal neuralgia is a disease with a clear etiology, and vascular compression in the trigeminal nerve into the pontine brain region is where the majority of the etiology lies. At present, microvascular decompression is the first choice for trigeminal neuralgia treatment at home and abroad. Microvascular decompression is a minimally invasive surgery, and the procedure can be broadcast live on TV . The vast majority of procedures are highly effective, with no more pain once awake from anesthesia, no further medication required, and no residual neurological impairment.All other treatments are not etiologic and have the potential for neurological impairment in addition to recurrence.

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Diagnostic Criteria Using The International Headache Society Definition

All patients fulfilled the criteria of the International Headache Society.10 Evaluation of the type of TN was made according to the classifications proposed by Eller et al.7 and comprised idiopathic TN1 and TN2. TN1 is described as typically sharp, shooting, electrical shock like, with pain-free intervals between attacks that is present for more than 50% of the time TN2 is described as an aching, throbbing, or burning pain that is present for more than 50% of the time and is constant in nature . Only patients fulfilling the criteria for the TN1 type were included. The preoperative MRI protocol included 3D T1-weighted images, with and without contrast, and T2 CISS without contrast.

Probability Of Pain Relief Without Medication

The probability of achieving and maintaining pain relief without medication at 0.5, 1, 2, 3, 5, 7, 10, 12 and 14 years was 93.4, 85.9, 78.6, 71.8, 64.9, 59.7, 45.3, 40.7 and 33.9%, respectively . The probability of remaining pain free was higher, with a shorter delay between TN pain onset and radiosurgery but was not influenced by the development of postradiosurgery hypesthesia or the existence of a neurovascular conflict on MRI , with the same applying to plugging . Furthermore, an earlier initial response predicted a better long-term benefit .

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What Is Recovery Like From Gamma Knife Treatment For Trigeminal Neuralgia

Gamma Knife is a minimally invasive treatment, so recovery is very mild and almost immediate. Patients do receive conscious sedation, so we encourage rest on the day of treatment after discharge. A few patients will have a headache or minor pain for a day or two at the four pin sites where the frame was anchored in position on the head, but most patients are able to resume normal daily activities within 24 hours.

Why Choose Rocky Mountain Gamma Knife Center

Gamma Knife Treatment for Trigeminal Neuralgia

The Rocky Mountain Gamma Knife Center is the regions most experienced center for stereotactic radiosurgery. Since performing the regions first-ever Gamma Knife procedure in 1993, Rocky Mountain Gamma Knife Center has continued to be the Rocky Mountains leader, providing Gamma Knife treatment for trigeminal neuralgia and more than 30 other types of brain conditions. More than 5,300 patients have benefited from treatment at Rocky Mountain Gamma Knife Center.

Our team has earned a reputation as experienced leaders in employing Gamma Knife technology for the treatment of 30 neurological disorders, including benign meningiomas and cancerous tumors, especially metastatic melanoma. In addition, our neurosurgeons are nationally recognized for expertise in treating the facial pain known as trigeminal neuralgia.

Radiosurgery with Gamma Knife is covered by most insurance plans. We can help you determine your coverage and get preauthorization.

To schedule an appointment to talk with a Rocky Mountain Gamma Knife Center nurse or for more information, fill out our online form to select a time or call 303-366-0099.

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Feasibility Of Multiple Repeat Gamma Knife Radiosurgeries For Trigeminal Neuralgia: A Case Report And Review Of The Literature

Christopher M. LeeAcademic Editor: Received

Abstract

Treatment options for trigeminal neuralgia must be customized for the individual patient, and physicians must be aware of the medical, surgical, and radiation treatment modalities to prescribe optimal treatment courses for specific patients. The following case illustrates the potential for gamma knife radiosurgery to be repeated multiple times for the purpose of achieving facial pain control in cases of TN that have been refractory to other medical and surgical options, as well as prior GKRS. The patient described failed to achieve pain control with initial GKRS, as well as medical and surgical treatments, but experienced significant pain relief for a period of time with a second GKRS procedure and later underwent a third procedure. Only a small subset of patients have reportedly undergone more than two GKRS for TN thus, further research and long-term clinical followup will be valuable in determining its usefulness in specific clinical situations.

1. Introduction

2. Case Report

Axial section through the brainstem at the nerve root entry zone of the left trigeminal nerve with an illustration of the location of the 50% isodose line for gamma knife radiation treatment planning. This was the treatment location for the first and second gamma knife procedures.

3. Discussion

4. Conclusion

Acknowledgments

References

  • E. K. Hansen, Ed., Handbook of Evidence-Based Radiation Oncology, Springer Science, New York, NY, USA, 2007.

  • Details Of Previous Treatments

    One hundred seventy-three patients had prior surgical procedures, of which 102 patients had only 1 previous intervention, 41 patients had 2 previous surgeries, and 30 had 3 or more previous surgeries.

    Previous surgeries consisted of radiofrequency ablation in 99 patients, balloon microcompression in 64 patients, MVD in 45 patients, and glycerol rhizotomy in 6 patients.

    Before GKS, 107 patients had sensory disturbance in relation to a previous surgical procedure, which consisted of slight hypesthesia in 99 and severe hypesthesia in 8 patients. GKS was the first surgical procedure in 324 patients . All patients had drug-resistant TN or major intolerance to all therapies. Two hundred sixty-three patients reported substantial side effects to drug therapy at the time of radiosurgery.

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    Who Is A Candidate For Gamma Knife Treatment For Trigeminal Neuralgia

    Gamma Knife surgery has long been recognized as the only option for many patients who, for health reasons, may not be candidates for conventional surgery. Most trigeminal neuralgia patients are good candidates, as no general anesthesia is required. Gamma Knife treatment for trigeminal neuralgia also is a good option for patients who want a nonsurgical treatment with little to no recovery time or side effects. The procedure also is particularly appropriate for patients who want to minimize risk of facial numbness or cannot tolerate general anesthesia.

    Because trigeminal neuralgia is a progressive condition, many patients find that medications that were initially effective eventually stop working. Others find that side effects of medications are not tolerable. For those patients, stereotactic radiosurgery with Gamma Knife is a preferred treatment option.

    At Rocky Mountain Gamma Knife Center, our team of specialists will carefully review your medical history and discuss treatment options with you to determine whether you are a good candidate for a Gamma Knife procedure.

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