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Stereotactic radiosurgery of essential trigeminal neuralgia using Leksell Gamma Knife model C with automatic positioning system

Technical nuances and evaluation of outcome in 130 patients with at least 2 years follow-up after treatment

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Abstract

The objective of the present study was the evaluation of outcome in 130 patients with essential trigeminal neuralgia, who were treated using Leksell Gamma Knife model C with automatic positioning system and followed at least 24 months thereafter. Radiosurgery was guided by fused thin-sliced magnetic resonance (MR) and “bone window” computed tomographic (CT) images. In all cases, retrogasserian part of the trigeminal nerve at the level of trigeminal incisura was selected as a target, and one 4-mm collimator was used for delivery of the maximum irradiation dose of 90 Gy. The coordinates of the isocenter were adjusted for positioning of the nerve in the center of 80% isodose area, and were corrected in each individual case with regard to presence of distortion artifacts on MR images. Initial relief of the typical paroxysmal facial pain was marked in 127 patients (98%) within a median interval of 3 weeks after treatment. However, in 23 patients the pain re-appeared later on. Overall, at the time of the last follow-up 112 patients (86%) were pain-free, including 86 who remained both pain- and medication-free after initial radiosurgery. In 31 cases (24%), treatment was complicated by facial hypesthesia and/or paresthesia. In conclusion, radiosurgery of essential trigeminal neuralgia results in a high rate of initial pain relief, but pain recurrences and associated complications are not uncommon. The outcome may be influenced by various technical nuances; therefore, treatment should be preferably done in specialized clinical centers with sufficient expertise in the management of this disorder.

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Acknowledgements

This work was supported by the Program for Promoting the Establishment of Strategic Research Centers, Special Coordination Funds for Promoting Science and Technology, Ministry of Education, Culture, Sports, Science and Technology (Japan). At the time of this study, Dr. Pavel Ivanov from the International Institute of the Biological Systems (Saint Petersburg, Russia) had a training fellowship in the Gamma Knife Unit of the Tokyo Women’s Medical University (Tokyo, Japan).

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Authors and Affiliations

  1. Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Motohiro Hayashi, Mikhail Chernov, Shoji Yomo, Manabu Tamura, Yoshihiro Muragaki, Hiroshi Iseki & Kintomo Takakura

  2. Department of Neurosurgery, Neurological Institute, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Motohiro Hayashi, Mikhail Chernov, Noriko Tamura, Takaomi Taira, Masahiro Izawa, Mariko Nagai, Yoshihiro Muragaki, Yoshikazu Okada, Hiroshi Iseki & Kintomo Takakura

  3. Saitama Gamma Knife Center, Sanai Hospital, Saitama, Japan

    Motohiro Hayashi & Shoji Yomo

  4. International Research and Educational Institute for Integrated Medical Sciences (IREIIMS), Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Mikhail Chernov, Hiroshi Iseki & Kintomo Takakura

  5. Department of Radiosurgery, International Institute of the Biological Systems, Saint Petersburg, Russia

    Mikhail Chernov & Pavel Ivanov

  6. Department of Neurosurgery, Show Chwan Memorial Hospital, Changhua, Taiwan

    Cheng-Siu Chang

Authors
  1. Motohiro Hayashi
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  2. Mikhail Chernov
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  3. Noriko Tamura
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  4. Takaomi Taira
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  5. Masahiro Izawa
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  6. Shoji Yomo
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  7. Mariko Nagai
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  8. Cheng-Siu Chang
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  9. Pavel Ivanov
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  10. Manabu Tamura
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  11. Yoshihiro Muragaki
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  12. Yoshikazu Okada
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  13. Hiroshi Iseki
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  14. Kintomo Takakura
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Corresponding author

Correspondence to Motohiro Hayashi.

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Comments

Ekkehard M Kasper, Boston, USA

This is a review of a retrospective cohort study, in which the authors evaluate a set of prospectively collected data regarding patients with idiopathic trigeminal neuralgia at a large Japanese Medical Center. The study is valuable, since it contributes to a field that is relevant to many neurosurgeons. We realize that SRS, and in particular GKS, has become one of the standard management options for TN in Asia. The authors report an excellent response rate at the time of last follow up. Data are coherent and compatible with the existing literature. However, it remains a worthwhile discussion 1) to see what causes this trend towards this first line management employing SRS vs. non-destructive methods such as MVD and 2) to reconsider whether this is acceptable, given the current evidence of a significantly shorter durability in cases of succesful responses. Current consensus in Europe and the US remains that destructive techniques are offered only as a second option, despite the convenience of SRS as requested per patient demands and more experience with redo SRS (see Huang et al., 2010; Kimball et al., 2010).The discussion part of the study is very well done and deserves particular credit.

The results of this study were presented during the 9th Biennial Congress of the International Stereotactic Radiosurgery Society (June 7–11, 2009; Seoul, South Korea).

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Hayashi, M., Chernov, M., Tamura, N. et al. Stereotactic radiosurgery of essential trigeminal neuralgia using Leksell Gamma Knife model C with automatic positioning system. Neurosurg Rev 34, 497–508 (2011). https://doi.org/10.1007/s10143-011-0330-9

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