Skip to main content
SpringerLink
Log in

TN-RS: a novel scoring system predicts Gamma Knife Radiosurgery outcome for trigeminal neuralgia patients

  • Original Article
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Gamma Knife Radiosurgery (GKRS) is an effective treatment option for medically refractory trigeminal neuralgia (TN). This study examines GKRS outcome in a large cohort of TN patients and highlights pretreatment factors associated with pain relief.

Methods

This is a single-center retrospective analysis of patients treated with GKRS for TN between 2011 and 2019. Pain relief was assessed at 1 year, and 2–3 years following GKRS. Multivariable analysis identified several factors that predicted pain relief. These predicting factors were applied to establish a pain relief scoring system.

Results

A total of 162 patients met inclusion criteria. At 1 year post-GKRS, the breakdown of Barrow Neurological Institute (BNI) score for pain relief was as follows: 77 (48%) score of I, 13 (8%) score of II, 37 (23%) score of III, 22 (14%) score of IV, and 13 (8%) score of V. Factors that were significantly associated with pain-free outcome at 1 year were: Typical form of TN (OR = 2.2 [1.1, 4.9], p = 0.049), No previous microvascular decompression (OR = 4.4 [1.6, 12.5], p = 0.005), Response to medical therapy (OR = 2.7 [1.1, 6.1], p = 0.018), and Seniority > 60 years (OR = 2.8 [1.4, 5.5], p = 0.003). The term “Trigeminal Neuralgia-RadioSurgery” was used to create the TN-RS acronym representing the significant factors. A stepwise increase in the median predicted probability of pain-free outcome at 1 year from 3% for patients with a score of 0 to 69% for patients with a maximum score of 4.

Conclusion

The TN-RS scoring system can assist clinicians in identifying patients that may benefit from GNRS for TN by predicting 1-year pain-free outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data availability

All data for this study can be shared upon reasonable request.

Code availability

Code and statistical analysis in this study can be shared upon reasonable request.

Abbreviations

GKRS:

Gamma Knife Radiosurgery

TN:

Trigeminal neuralgia

BNI:

Barrow Neurological Institute

SRS:

Stereotactic radiosurgery

MVD:

Microvascular decompression

References

  1. Barzaghi LR, Albano L, Scudieri C, Gigliotti CR, del Vecchio A, Mortini P (2021) Factors affecting long-lasting pain relief after Gamma Knife radiosurgery for trigeminal neuralgia: a single institutional analysis and literature review. Neurosurg Rev 44(5):2797–2808. https://doi.org/10.1007/s10143-021-01474-9

    Article  PubMed  Google Scholar 

  2. Bijlenga P, Gondar R, Schilling S et al (2017) PHASES score for the management of intracranial aneurysm: a cross-sectional population-based retrospective study. Stroke 48(8):2105–2112. https://doi.org/10.1161/STROKEAHA.117.017391

    Article  PubMed  Google Scholar 

  3. Chen JCT, Greathouse HE, Girvigian MR, Miller MJ, Liu A, Rahimian J. Prognostic factors for radiosurgery treatment of trigeminal neuralgia. https://doi.org/10.1227/01.NEU.0000297100.34508.0B

  4. Dhople AA, Adams JR, Maggio WW, Naqvi SA, Regine WF, Kwok Y (2009) Long-term outcomes of Gamma Knife radiosurgery for classic trigeminal neuralgia: implications of treatment and critical review of the literature: Clinical article. J Neurosurg 111(2):351–358. https://doi.org/10.3171/2009.2.JNS08977

    Article  PubMed  Google Scholar 

  5. Eller JL, Raslan AM, Burchiel KJ (2005) Trigeminal neuralgia: definition and classification. Neurosurg Focus 18(5). https://doi.org/10.3171/FOC.2005.18.5.4

  6. Fatima N, Meola A, Ding VY, et al (2021) The Stanford stereotactic radiosurgery experience on 7000 patients over 2 decades (1999–2018): looking far beyond the scalpel. J Neurosurg 1–17. https://doi.org/10.3171/2020.9.JNS201484

  7. Foreman PM, Enriquez-Marulanda A, Mooney JH, et al (2018) Whole blood aggregometry prior to pipeline embolization device treatment of intracranial aneurysms: defining an optimal platelet inhibition cutoff value for clopidogrel. J Neurosurg 1–8. https://doi.org/10.3171/2018.6.JNS181044

  8. Gorgulho A (2012) Radiation mechanisms of pain control in classical trigeminal neuralgia. Surg Neurol Int 3(Suppl 1):S17. https://doi.org/10.4103/2152-7806.91606

    Article  PubMed  PubMed Central  Google Scholar 

  9. Goyal S, Kedia S, Kumar R et al (2021) Role of Gamma Knife radiosurgery in trigeminal neuralgia—its long term outcome and prediction using Artificial neural Network model. J Clin Neurosci 92:61–66. https://doi.org/10.1016/j.jocn.2021.07.017

    Article  PubMed  Google Scholar 

  10. Helis CA, Hughes RT, Munley MT et al (2020) Results of a third Gamma Knife radiosurgery for trigeminal neuralgia. J Neurosurg 134(3):1237–1243. https://doi.org/10.3171/2020.2.JNS192876

    Article  PubMed  Google Scholar 

  11. Kondziolka D, Zorro O, Lobato-Polo JE et al (2010) Gamma Knife stereotactic radiosurgery for idiopathic trigeminal neuralgia: Clinical article. J Neurosurg 112(4):758–765. https://doi.org/10.3171/2009.7.JNS09694

    Article  PubMed  Google Scholar 

  12. Li L, Seaman SC, Bathla G et al (2020) Microvascular decompression versus stereotactic radiosurgery for trigeminal neuralgia: a single-institution experience. World Neurosurg 143:e400–e408. https://doi.org/10.1016/j.wneu.2020.07.161

    Article  PubMed  Google Scholar 

  13. Little AS, Shetter AG, Shetter ME, Kakarla UK, Rogers CL (2009) Salvage gamma knife stereotactic radiosurgery for surgically refractory trigeminal neuralgia. Int J Radiat Oncol Biol Phys 74(2):522–527. https://doi.org/10.1016/J.IJROBP.2008.08.048

    Article  PubMed  Google Scholar 

  14. Liu M, Wood JN (2011) The roles of sodium channels in nociception: implications for mechanisms of neuropathic pain. Pain Med 12(SUPPL. 3):S93–S99. https://doi.org/10.1111/J.1526-4637.2011.01158.X/2/PME_1158_F1.JPEG

    Article  PubMed  Google Scholar 

  15. Loeser JD, Calvin WH, Howe JF (2009) The pathophysiology of trigeminal neuralgia. Clin Neurosurg 24:2359–2419. https://doi.org/10.1007/978-3-540-69960-6_140

    Article  Google Scholar 

  16. 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(6):1254–1261. https://doi.org/10.1227/01.NEU.0000306104.68635.D4

    Article  PubMed  Google Scholar 

  17. Maesawa S, Salame C, Flickinger JC, Pirris S, Kondziolka D, Lunsford LD (2001) Clinical outcomes after stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 94(1):14–20. https://doi.org/10.3171/JNS.2001.94.1.0014

    Article  CAS  PubMed  Google Scholar 

  18. Marshall K, Chan MD, McCoy TP, et al (2012) Predictive variables for the successful treatment of trigeminal neuralgia with gamma knife radiosurgery. Neurosurgery 70(3). https://doi.org/10.1227/NEU.0B013E3182320D36

  19. Park H, Jeong SS, Chung HT, Lee EJ (n.d.) Treatment planning factors associated with long-term outcomes of gamma knife surgery in patients with trigeminal neuralgia. https://doi.org/10.1016/j.wneu.2021.05.008

  20. Park H, Jeong SS, Chung HT, Lee EJ (2021) Treatment planning factors associated with long-term outcomes of Gamma Knife surgery in patients with trigeminal neuralgia. World Neurosurg 151:e899–e910. https://doi.org/10.1016/j.wneu.2021.05.008

    Article  PubMed  Google Scholar 

  21. Régis J, Constantin T, Resseguier N et al (2016) Long-term safety and efficacy of Gamma Knife surgery in classical trigeminal neuralgia: a 497-patient historical cohort study. J Neurosurg 124:1079–1087. https://doi.org/10.3171/2015.2.JNS142144

    Article  PubMed  Google Scholar 

  22. Rogers CL, Shetter AG, Fiedler JA, Smith KA, Han PP, Speiser BL (2000) Gamma knife radiosurgery for trigeminal neuralgia: the initial experience of the Barrow Neurological Institute. Int J Radiat Oncol Biol Phys 47(4):1013–1019. https://doi.org/10.1016/S0360-3016(00)00513-7

    Article  CAS  PubMed  Google Scholar 

  23. Schisterman EF, Perkins NJ, Liu A, Bondell H (2005) Optimal cut-point and its corresponding Youden Index to discriminate individuals using pooled blood samples. Epidemiology 16(1):73–81. https://doi.org/10.1097/01.ede.0000147512.81966.ba

    Article  PubMed  Google Scholar 

  24. Taich ZJ, Goetsch SJ, Monaco E, et al (2016) Stereotactic radiosurgery treatment of trigeminal neuralgia: clinical outcomes and prognostic factors. https://doi.org/10.1016/j.wneu.2016.02.067

  25. Tuleasca C, Paddick I, Hopewell JW et al (2020) Establishment of a therapeutic ratio for gamma knife radiosurgery of trigeminal neuralgia: the critical importance of biologically effective dose versus physical dose. World Neurosurg 134:e204–e213. https://doi.org/10.1016/J.WNEU.2019.10.021

    Article  PubMed  Google Scholar 

  26. Tuleasca C, Régis J, Sahgal A et al (2019) Stereotactic radiosurgery for trigeminal neuralgia: a systematic review. J Neurosurg 130(3):733–757. https://doi.org/10.3171/2017.9.JNS17545

    Article  Google Scholar 

  27. Verheul JB, Hanssens PEJ, Lie S te, Leenstra S, Piersma H, Beute GN (2010) Gamma Knife surgery for trigeminal neuralgia: a review of 450 consecutive cases: clinical article. J Neurosurg 113(Special_Supplement):160–167. https://doi.org/10.3171/2010.7.GKS10978

  28. Vittinghoff E, McCulloch CE (2007) Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol 165(6):710–718. https://doi.org/10.1093/aje/kwk052

    Article  PubMed  Google Scholar 

  29. Wilson TA, Karlsson B, Huang L, Ramanathan D, Oyoyo U, Boling W (2020) Optimizing radiosurgery for trigeminal neuralgia: impact of radiation dose and anatomic target on patient outcomes. World Neurosurg 143:e482–e491. https://doi.org/10.1016/j.wneu.2020.07.206

    Article  PubMed  Google Scholar 

  30. Xu R, Xie ME, Jackson CM (2021) Trigeminal neuralgia: current approaches and emerging interventions. J Pain Res 14:3437–3463. https://doi.org/10.2147/JPR.S331036

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Young RF, Vermeulen S, Posewitz A (1998) Gamma knife radiosurgery for the treatment of trigeminal neuralgia. Stereotact Funct Neurosurg 70 Suppl 1(SUPPL. 1):192–199. https://doi.org/10.1159/000056422

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Alon Orlev and James Feghali contributed equally to the manuscript.

Authors and Affiliations

  1. Swedish Neuroscience Institute, Seattle, WA, USA

    Alon Orlev, Clifford Pierre, Cristian Gragnaniello & Zachary Litvack

  2. Department of Neurosurgery, Rabin Medical Center, Affiliated to Sackler Medical School, 39 Jabotynski St., 49414, Petach Tikva, Israel

    Alon Orlev

  3. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    James Feghali

  4. Department of Neurosurgery, Sheba Medical Center, Ramat-Gan, Affiliated to Sackler Medical School, Tel-Aviv University, Tel-Aviv, Israel

    Gil Kimchi

  5. Department of Biology, University of Washington, Bothell, WA, USA

    Lian Sun

  6. Department of Neurosurgery, Long School of Medicine, University of Texas, San Antonio, TX, USA

    Cristian Gragnaniello

  7. Swedish Radiosurgery Center, Seattle, WA, USA

    Cristian Cotrutz, Christopher Loiselle & Sandra Vermeulen

Authors
  1. Alon Orlev
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. James Feghali
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gil Kimchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lian Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Clifford Pierre
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Cristian Gragnaniello
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Cristian Cotrutz
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Christopher Loiselle
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Sandra Vermeulen
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Zachary Litvack
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by AO, JF, GK, CP, CG, CC, and LS. The first draft of the manuscript was written by AO, JF, GK, and CC. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Alon Orlev.

Ethics declarations

Ethical approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Swedish Neuroscience Institute approved this study.

Consent to participate

No identifying patient information was presented in this study.

Consent for publication

Authors are responsible for correctness of the statements provided in the manuscript.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Orlev, A., Feghali, J., Kimchi, G. et al. TN-RS: a novel scoring system predicts Gamma Knife Radiosurgery outcome for trigeminal neuralgia patients. Acta Neurochir 165, 3895–3903 (2023). https://doi.org/10.1007/s00701-023-05835-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-023-05835-9

Keywords

Search

Navigation