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Gamma Knife radiosurgery for the treatment of cluster headache: a systematic review

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Abstract

Cluster headache (CH) is a severe trigeminal autonomic cephalalgia that, when refractory to medical treatment, can be treated with Gamma Knife radiosurgery (GKRS). The outcomes of studies investigating GKRS for CH in the literature are inconsistent, and the ideal target and treatment parameters remain unclear. The aim of this systematic review is to evaluate the safety and the efficacy, both short and long term, of GKRS for the treatment of drug-resistant CH. A systematic review of the literature was performed to identify all clinical articles discussing GKRS for the treatment of CH. The literature review revealed 5 studies describing outcomes of GKRS for the treatment of CH for a total of 52 patients (48 included in the outcome analysis). The trigeminal nerve, the sphenopalatine ganglion, and a combination of both were treated in 34, 1, and 13 patients. The individual studies demonstrated initial meaningful pain reduction in 60–100% of patients, with an aggregate initial meaningful pain reduction in 37 patients (77%). This effect persisted in 20 patients (42%) at last follow-up. Trigeminal sensory disturbances were observed in 28 patients (58%) and deafferentation pain in 3 patients (6%). Information related to GKRS for CH are limited to few small open-label studies using heterogeneous operative techniques. In this setting, short-term pain reduction rates are high, whereas the long-term results are controversial. GKRS targeted on the trigeminal nerve or sphenopalatine ganglion is associated to a frequent risk of trigeminal disturbances and possibly deafferentation pain.

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Authors and Affiliations

  1. Department of Neurosurgery, Humanitas Research Hospital - IRCCS, via Manzoni 56, 20089, Rozzano, Mi, Italy

    Andrea Franzini & Piero Picozzi

  2. Department of Radiation Oncology, Humanitas Research Hospital - IRCCS, Rozzano, Mi, Italy

    Elena Clerici & Pierina Navarria

Authors
  1. Andrea Franzini
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  2. Elena Clerici
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  3. Pierina Navarria
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  4. Piero Picozzi
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Contributions

Concept and design: Franzini, Clerici, Picozzi. Acquisition of data: Franzini. Analysis and interpretation of data: Franzini, Clerici. Drafting the article: Franzini. Critically revising the article: all the authors.

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Correspondence to Andrea Franzini.

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Franzini, A., Clerici, E., Navarria, P. et al. Gamma Knife radiosurgery for the treatment of cluster headache: a systematic review. Neurosurg Rev 45, 1923–1931 (2022). https://doi.org/10.1007/s10143-021-01725-9

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  • DOI: https://doi.org/10.1007/s10143-021-01725-9

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