Abstract
The trigeminal neuralgia (TN) is a chronic, episodic, and disabling facial pain syndrome. It is a relatively rare disorder. Despite this, because of the intensity of the pain, TN may have a dramatic impact for many patients. Fortunately, most of the patients may obtain a good pain relief simply by taking drugs. Historically, the surgical approaches represent a true treatment paradigm for all the drug-resistant TN. In this context, radiosurgery (RS) is a relatively new treatment modality. The effectiveness and safety of radiosurgery are today widely accepted and the technique can be proposed to many patients which suffer from a drug-resistant TN. This is true especially when the patients are less than ideal candidates for an open surgery, or for elderly ones, when a clear neuro-vascular conflict is not evident. The present review provides a concise analysis of the actual indications for radiosurgery, as well as the most acknowledged prognostic factors. The pathogenesis of TN and the rationale for the RS efficacy are also investigated and described. Some technical aspects including the target selection and the prescription doses, which have widely changed in time, are depicted. In conclusion, the present review supports the idea that TN is a complex disease and radiosurgery represents an effective and relatively new treatment modality, which enriches the treatment armamentarium for these unfortunate patients. To optimize the RS results, a correct patient selection has to be performed.
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References
Rose FC (1999) Trigeminal neuralgia. Arch Neurol 56:1163–1164
Patel SK, Liu JK (2016) Overview and history of trigeminal neuralgia. Neurosurg Clin N Am 27(3):265–276
Brown JA, Coursaget C, Preul MC, Sangvai D (1999) Mercury water and cauterizing stones: Nicolas André and tic douloureux. J Neurosurg 90:977–981
Fothergill J (1773) Of a painful affection of the face. Medical observations and inquires by a society of physicians. Med Observ Inquir 5:129–142
Katusic S, Beard CM, Bergstralh E, Kurland LT (1990) Incidence and clinical features of trigeminal neuralgia, Rochester, Minnesota, 1945-1984. Ann Neurol 27(1):89–95
Childs AM, Meaney JF, Ferrie CD, Holland PC (2000) Neurovascular compression of the trigeminal and glossopharyngeal nerve: three case reports. Arch Dis Child 82:311–355
Fleetwood IG, Innes AM, Hansen SR, Steinberg GK (2001) Familial trigeminal neuralgia. Case report and review of the literature. J Neurosurg 95:513–517
Love S, Coakham HB (2001) Trigeminal neuralgia: pathology and pathogenesis. Brain 124:2347–2360
Love S, Hilton DA, Coakham HB (1998) Central demyelination of the Vth nerve root in trigeminal neuralgia associated with vascular compression. Brain Pathol 8:1–11
Devor M, Amir R, Rappaport ZH (2002) Pathophysiology of trigeminal neuralgia: the ignition hypothesis. Clin J Pain 18:4–13
Headache Classification Committee of the International Headache Society (IHS) (2013) The international classification of headache disorders, 3rd edition (beta version). Cephalalgia 33:629–808
Eller JL, Raslan AM, Burchiel KJ (2005) Trigeminal neuralgia: definition and classification. Neurosurg Focus 18:E3
Campbell FG, Graham JG, Zilkha KJ (1966) Clinical trial of carbazepine (tegretol) in trigeminal neuralgia. J Neurol Neurosurg Psychiatry 29:265–267
Barker FG 2nd, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD (1996) The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334:1077–1083
Xia L, Zhong J, Zhu J, Wang YN, Dou NN, Liu MX, Visocchi M, Li ST (2014) Effectiveness and safety of microvascular decompression surgery for treatment of trigeminal neuralgia: a systematic review. J Craniomaxillofac Surg 25:1413–1417
Broggi G, Ferroli P, Franzini A, Servello D, Dones I (2000) Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases, including 10 patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 68:59–64
Broggi G, Franzini A (1982) Radiofrequency trigeminal rhizotomy in treatment of symptomatic non-neoplastic facial pain. J Neurosurg 57(4):483–486
Gronseth G, Cruccu G, Alksne J, Argoff C, Brainin M, Burchiel K, Nurmikko T, Zakrzewska JM (2008) Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidencebased review): report of the quality standards Subcommittee of the American Academy of neurology and the European Federation of Neurological Societies. Neurology. 71:1183–1190
Rogers CL, Speiser BL (2000) Gamma knife radiosurgery for trigeminal neuralgia: the initial experience of the Barrow Neurological Institute. Int J Radiat Oncol Biol Phys 47:1013–1019
Nicol B, Regine WF, Courtney C, Meigooni A, Sanders M, Young B (2000) Gamma knife radiosurgery using 90 Gy for trigeminal neuralgia. J Neurosurg 93(3):152–154
Kondziolka D, Zorro O, Lobato-Polo J, Kano H, Flannery TJ, Flickinger JC, Lunsford LD (2010) Gamma knife stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 112(4):758–765
Villavicencio AT, Lim M, Burneikiene S, Romanelli P, Adler JR, McNeely L, Chang SD, Fariselli L, McIntyre M, Bower R, Broggi G, Thramann JJ (2008) Cyberknife radiosurgery for trigeminal neuralgia treatment: a preliminary multicenter experience. Neurosurgery 62(3):647–655 discussion 647-55
Fariselli L, Marras C, De Santis M, Marchetti M, Milanesi I, Broggi G (2009) CyberKnife radiosurgery as a first treatment for idiopathic trigeminal neuralgia. Neurosurgery 64(2):A96–A101
Régis J, Tuleasca C, Resseguier N, Carron R, Donnet A, Yomo S, Gaudart J, Levivier M (2016) The very long-term outcome of radiosurgery for classical trigeminal neuralgia. Stereotact Funct Neurosurg 94(1):24–32
Régis J, Tuleasca C, Resseguier N, Carron R, Donnet A, Gaudart J, Levivier M (2016) Long-term safety and efficacy of gamma knife surgery in classical trigeminal neuralgia: a 497-patient historical cohort study. J Neurosurg 124(4):1079–1087
Longhi M, Rizzo P, Nicolato A, Foroni R, Reggio M, Gerosa M (2007) Gamma knife radiosurgery for trigeminal neuralgia: results and potentially predictive parameters—part I: idiopathic trigeminal neuralgia. Neurosurgery 61:1254–1261
Tuleasca C, Régis J, Sahgal A, De Salles A, Hayashi M, Ma L et al (2018) Stereotactic radiosurgery for trigeminal neuralgia: a systematic review. J Neurosurg 1:1–25
Hodaie M, Chen DQ, Quan J, Laperriere N (2012) Tractography delineates microstructural changes in the trigeminal nerve after focal radiosurgery for trigeminal neuralgia. PLoS One 7(3):e32745
Kondziolka D, Flickinger JC, Lunsford LD, Habeck M (1996) Trigeminal neuralgia radiosurgery: the University of Pittsburgh experience. Stereotact Funct Neurosurg 66(1):343–348
Zhao ZF, Yang LZ, Jiang CL, Zheng YR, Zhang JW (2010) Gamma knife irradiation-induced histopathological changes in the trigeminal nerves of rhesus monkeys. J Neurosurg 113:39–44
Tuleasca C, Carron R, Resseguier N, Donnet A, Roussel P, Gaudart J, Levivier M, Régis J (2014) Multiple sclerosis-related trigeminal neuralgia: a prospective series of 43 patients treated with gamma knife surgery with more than one year of follow-up. Stereotact Funct Neurosurg 92:203–210
Weller M, Marshall K, Lovato JF, Bourland JD, deGuzman AF, Munley MT et al (2014) Single-institution retrospective series of gamma knife radiosurgery in the treatment of multiple sclerosis-related trigeminal neuralgia: factors that predict efficacy. Stereotact Funct Neurosurg 92:53–58
Zorro O, Lobato-Polo J, Kano H, Flickinger JC, Lunsford LD, Kondziolka D (2009) Gamma knife radiosurgery for multiple sclerosis-related trigeminal neuralgia. Neurology 73(14):1149–1154
Conti A, Pontoriero A, Iatì G, Esposito F, Siniscalchi EN, Crimi S, Vinci S, Brogna A, de Ponte F, Germanò A, Pergolizzi S, Tomasello F (2017) Frameless stereotactic radiosurgery for treatment of multiple sclerosis-related trigeminal neuralgia. World Neurosurg 103:702–712
Tuleasca C, Carron R, Resseguier N, Donnet A, Roussel P, Gaudart J, Levivier M, Régis J (2014) Trigeminal neuralgia related to megadolichobasilar artery compression: a prospective series of twenty-nine patients treated with gamma knife surgery, with more than one year of follow-up. Stereotact Funct Neurosurg 92(3):170–177
Park KJ, Kondziolka D, Kano H, Berkowitz O, Ahmed SF, Liu X, Niranjan A, Flickinger JC, Lunsford LD (2012) Outcomes of gamma knife surgery for trigeminal neuralgia secondary to vertebrobasilar ectasia. J Neurosurg 116:73–81
Tan DY, Chua ET, Ng KB, Chan KP, Thomas J (2013) Frameless linac-based stereotactic radiosurgery treatment for SUNCT syndrome targeting the trigeminal nerve and sphenopalatine ganglion. Cephalalgia. 33(13):1132–1136
Lucas JT Jr, Nida AM, Isom S, Marshall K, Bourland JD, Laxton AW, Tatter SB, Chan MD (2014) Predictive nomogram for the durability of pain relief from gamma knife radiation surgery in the treatment of trigeminal neuralgia. Int J Radiat Oncol Biol Phys 89(1):120–126
Rogers CL, Shetter AG, Ponce FA, Fiedler JA, Smith KA, Speiser BL (2002) Gamma knife radiosurgery for trigeminal neuralgia associated with multiple sclerosis. J Neurosurg 97(5):529–532
Mousavi SH, Niranjan A, Huang MJ, Laghari FJ, Shin SS, Mindlin JL, Flickinger JC, Lunsford LD (2015) Early radiosurgery provides superior pain relief for trigeminal neuralgia patients. Neurology 85(24):2159–2165
Brisman R, Khandji AG, Mooij RB (2002) Trigeminal nerve-blood vessel relationship as revealed by high-resolution magnetic resonance imaging and its effect on pain relief after gamma knife radiosurgery for trigeminal neuralgia. Neurosurgery 50(6):1261–1266
Marshall K, Chan MD, McCoy TP, Aubuchon AC, Bourland JD, McMullen KP et al (2012) Predictive variables for the successful treatment of trigeminal neuralgia with gamma knife radiosurgery. Neurosurgery 70(3):566–572
Pollock BE, Phuong LK, Gorman DA, Foote RL, Stafford SL (2002) Stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 97(2):347–353
Park SH, Hwang SK, Kang DH, Park J, Hwang JH, Sung JK (2010) The retrogasserian zone versus dorsal root entry zone: comparison of two targeting techniques of gamma knife radiosurgery for trigeminal neuralgia. Acta Neurochir 152:1165–1170
Xu Z, Schlesinger D, Moldovan K, Przybylowski C, Sun X, Lee CC, Yen CP, Sheehan J (2014) Impact of target location on the response of trigeminal neuralgia to stereotactic radiosurgery. J Neurosurg 120:716–724
Lim M, Cotrutz C, Romanelli P, Schaal D, Gibbs I, Chang SD, Adler JR (2006) Stereotactic radiosurgery using CT cisternography and non-isocentric planning for the treatment of trigeminal neuralgia. Comput Aided Surg 11:11–20
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Marchetti, M., Pinzi, V., De Martin, E. et al. Radiosurgery for trigeminal neuralgia: the state of art. Neurol Sci 40 (Suppl 1), 153–157 (2019). https://doi.org/10.1007/s10072-019-03814-6
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DOI: https://doi.org/10.1007/s10072-019-03814-6