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Repeat Gamma Knife radiosurgery for recurrent trigeminal neuralgia in patients with multiple sclerosis: a single-center retrospective study

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Abstract

Purpose

Gamma Knife radiosurgery (GKRS) has emerged as an effective treatment option for trigeminal neuralgia (TN) in patients with multiple sclerosis (MS). To date, the outcomes of repeat GKRS for patients with TN and MS with recurrent pain have been investigated in a few patients. This study aims to report the outcomes and predictive factors of pain reduction for MS patients undergoing repeat GKRS for recurrent TN.

Methods

Eighteen patients with MS underwent repeat GKRS for recurrent TN. A retrospective chart review and telephone interviews were conducted to determine background medical history, dosimetric data, and outcomes of the procedure. Facial pain and sensory function were evaluated using the Barrow Neurological Institute (BNI) scales.

Results

Fifteen patients achieved a BNI pain score of IIIa or better, indicating pain reduction, within a median period of 21 days after repeat GKRS. The maximum dose for repeat GKRS ranged from 70 to 85 Gy. Pain recurred in 5 patients after a median period of 12 months after GKRS. Percentages of patients with pain reduction at 1, 2, 3, 5, and 7 years were 60%, 60%, 50%, 50%, and 50%, respectively. Older age at repeat GKRS predicted sustained pain reduction (P = 0.01). Seven patients developed facial sensory disturbances, which were bothersome in two patients.

Conclusions

Repeat GKRS may be used as an effective treatment modality for prolonging the duration of pain reduction time in patients with MS and TN. After repeat GKRS, facial sensory disturbances are common; however, they are often not bothersome.

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Data Availability

The data that support the findings of this study are not openly available due to reasons of privacy, but are available from the authors upon reasonable request and with permission from IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano (Milano), Italy.

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Funding

This work was supported by IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano (Milano), Italy.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Milan, Rozzano, Italy

    Andrea Franzini, Piero Picozzi, Ali Baram & Federico Pessina

  2. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Milan, Rozzano, Italy

    Ali Baram & Federico Pessina

  3. Department of Radiation Oncology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Milan, Rozzano, Italy

    Pierina Navarria, Marta Scorsetti & Stefano Tomatis

Authors
  1. Andrea Franzini
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  2. Piero Picozzi
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Contributions

Material preparation, data collection, and analysis were performed by Andrea Franzini and Stefano Tomatis. The first draft of the manuscript was written by Andrea Franzini, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Andrea Franzini.

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Ethics approval

This retrospective study was approved by the ethics committee of IRCCS Humanitas Research Hospital. The present study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

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All authors approved the submission of the present article.

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The authors declare no competing interests.

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Franzini, A., Picozzi, P., Baram, A. et al. Repeat Gamma Knife radiosurgery for recurrent trigeminal neuralgia in patients with multiple sclerosis: a single-center retrospective study. Acta Neurochir 166, 15 (2024). https://doi.org/10.1007/s00701-024-05913-6

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