Radiation Oncology/CNS/Trigeminal neuralgia/Retrospective

Trigeminal Neuralgia Retrospective Studies Maryland 2007 (1996-2004) 17467919 -- "Efficacy and quality of life outcomes in patients with atypical trigeminal neuralgia treated with gamma-knife radiosurgery." (Dhople A, Int J Radiat Oncol Biol Phys. 2007 Oct 1;69(2):397-403. Epub 2007 Apr 30.) Retrospective. 35 patients with atypical TN, Group I (atypical TN) 57%, Group II (typical progress to atypical) 43%. RT median 75 Gy (70-80 Gy). Median F/U 2.4 years Pain control: 72% excellent/good relief, mean time to relief 5.8 weeks (0-24). Mean duration of relief 14 months. Comparable to typical TN at same institution Side effects: 19% bothersome numbness Conclusion: Aytpical TN similar outcomes to classical TN 2003 12829153 1996-2001 -- "Radiosurgical treatment of trigeminal neuralgia: evaluating quality of life and treatment outcomes." (Petit JH, Int J Radiat Oncol Biol Phys. 2003 Jul 15;56(4):1147-53.) Retrospective. 96/112 patients. RT dose 75 Gy (70-80 Gy). Questionnaire containing BNI and McGill pain scales. Median f/u 30 months Pain relief: 77% after median 3 weeks (0-24 weeks), 66% had decrease in meds use. Response associated with lack of prior surgical treatment and <50 month pain duration. QOL: If sustained pain relief - 100% improvement in QOL and 100% belief in success, if temporary pain relief - 80% improvement in QOL and 65% belief in success Side effects: 7% trigeminal dysfunction, 3% bothersome Georgia, 2006 16825804 -- "Outcome of Patients Undergoing Gamma Knife Stereotactic Radiosurgery for Medically Refractory Idiopathic Trigeminal Neuralgia: Medical College of Georgia's Experience." (Fountas KN, Stereotact Funct Neurosurg. 2006;84(2-3):88-96.) Retrospective. 77 patients. Pain control: no prior surgery 92% vs. prior surgery 84%, excellent outcome at 3 years 54% vs. 12%, good outcome 19% vs. 32% Side effects: facial numbness San Diego Gamma Knife Center, 2006 NSA Abstract -- "Dose response of Gamma Knife surgery for trigeminal neuralgia and high-dose salvage of failed Gamma Knife surgery" (Ott K, Neurosurgical Society of America Abstract, 2006) Retrospective. 263 patients treated, 26 retreated. RT dose range 26-140 Gy. Average f/u 32 months Pain control: Typical TN 85% excellent/good, Atypical TN 46% excellent/good. Dose response present, now use 97 Gy for both treatment and retreatment. Side effects: >50% facial numbness, usually transient. Better pain control results Retreatment: Same benefit. Comparable facial numbness, better response. Some with fair/poor/no response initially had excellent response on retreatment Washington University, 2005 16205107 -- "Gamma knife radiosurgery for trigeminal neuralgia: the Washington University initial experience." (Drzymala RE, Stereotact Funct Neurosurg. 2005;83(4):148-52.) Retrospective. 73 patients. RT 76-87 Gy. Outcome (naive vs. prior surgery): complete pain relief 59% vs. 33%; >=50% pain reduction 25% vs. 28%, no relief 16% vs. 28% Side effects: 15% numbness/paresthesias, 2% bothersome USC, 2005 1997-2003 15918946 -- "Gamma knife radiosurgery for trigeminal neuralgia." (NcNatt SA, Neurosurgery. 2005 Jun;56(6):1295-301; discussion 1301-3.) Retrospective. 49 patients. RT 40 Gy to 50% isodose, max 80 gy. 16% prior GR, 16% prior MVD. Median f/u 49 months Pain relief 61% (BNI I-III), including 32% complete pain relief. Recurrence 29%, median time 9.6 months Side effects: 29% mild/moderate facial numbness, 18% mild dysesthesias Louisiana State 2005 15913284 2000-2004 -- "Assessment of pain control, quality of life, and predictors of success after gamma knife surgery for the treatment of trigeminal neuralgia." (Jawahar A, Neurosurg Focus. 2005 May 15;18(5):E8.) Retrospective. 52/81 patients treated responded to questionnaire. Median f/u 16.5 months Pain control: 42% complete, 27% partial, 31% failed. Recurrence 13%. Overall satisfaction 80% 2004 15165787 -- "Gamma knife radiosurgery for trigeminal neuralgia: a study of predictors of success, efficacy, safety, and outcome at LSUHSC." (Shaya M, Surg Neurol. 2004 Jun;61(6):529-34; discussion 534-5.) Retrospective. 41 patients. RT 70-90 Gy. Median f/u 14 months Pain control: 40% excellent, 30% good, 30% failed. Vascular compression on MRI did not impact outcome. Improvement with dose >=80 Gy 2002 11892881 -- "First 100 cases of gamma knife radiosurgery in Louisiana: analysis of demographics and early results." (Jawahar A, J La State Med Soc. 2002 Jan-Feb;154(1):31-6.) GK commissioned 01/2000. Mets main indication, TN an indication Rosewell Park, 2005 15796377 -- "Stereotactic gamma knife surgery for trigeminal neuralgia: detailed analysis of treatment response." (Tawk RG, J Neurosurg. 2005 Mar;102(3):442-9.) Retrospective. 38 patients. RT to 35, 40, or 45 Gy to 50% isodose via 4-mm. Median follow-up 24 months Pain relief (@24 months): 21% excellent/good, 3% fair, 50% poor, 26% still in f/u Side effects: 37% facial numbness, dose related. But, higher pain relief in patients with facial numbness No effect of dose (70Gy vs. 90Gy) Virginia, 2005 1996-2003 15796376 -- "Gamma knife surgery for trigeminal neuralgia: outcomes and prognostic factors." (Sheehan J, J Neurosurg. 2005 Mar;102(3):434-41.) Retrospective. 151 patients (14 repeats, 1 tripeat). RT 50-90 Gy, target 2-4mm anterior to entry into pons. Median f/u 19 months Pain relief: 47% pain free/no meds at 1 year, 34% at 3 years. 90% some improvement at 1 year, 70% at 3 years. Mean time-to-relief 24 days (1,180). Relapse: 27% at median 12 months (2,34) Side effects: 9% facial numbness, correlated with undergoing >1 GK Prague (Czech) 2005 15662776 -- "Treatment of essential trigeminal neuralgia with gamma knife surgery." (Urgosik D, J Neurosurg. 2005 Jan;102 Suppl:29-33.) Retrospective. 107 patients. RT 70-80 Gy. Median f/u 60 months. Repeat in 19 patients, same dose. Pain relief: Initial 96% (complete 80%). Median time to improvement 3 months (1 day, 13 months). Recurrence 25%, median interval 36 months (6, 94). Retreatment: 19 patients (17%), initial pain relief 89% (complete 58%). Relapse 1 patient thus far Side effects: Hypesthesia 20% after first GK, 32% after second GK. Median interval 35 months (3, 94) after first GK, 21 months (1, 72) after second 2000 11143238 1995-1999 -- "Treatment of postherpetic trigeminal neuralgia with the gamma knife." (Urgosik D, J Neurosurg. 2000 Dec;93 Suppl 3:165-8.) Retrospective. 16 patients treated for postherpetic TN. RT 70-80 Gy. Mean f/u 33 months Pain relief: Success (excellent, very good, good) in 44%, failure in 56%. Pain relief after median 1 month Side effects: none 1998 9782252 1995-1996 -- "Gamma knife treatment of trigeminal neuralgia: clinical and electrophysiological study." (Urgosik D, Stereotact Funct Neurosurg. 1998 Oct;70 Suppl 1:200-9.) Retrospective. 49 patients, 31 essential TN, 7 MS-TN, 3 atypical TN, 8 postherpetic TN Pain control (excellent, very good, good): EN 77%, MSTN 43%, ATN 33%, PTN 38%. Median relief 2 months Side effects: hypesthesia 6%, 11% slight electrophysiological changes Columbia 2004 15137604 -- "Gamma knife surgery with a dose of 75 to 76.8 Gray for trigeminal neuralgia." (Brisman R, J Neurosurg. 2004 May;100(5):848-54.) Retrospective. 293 patients. Median f/u 1.9 years Final pain relief: 22% complete, 30% mostly (>90%, minor meds), 92% good (>50%). Recurrence requiring 2 GKS in 70 patients (24%) Side effects: dysesthesia >5/10 in 3% Atypical TN less likely to attain pain relief 2000 11143236 -- "Gamma knife radiosurgery for primary management for trigeminal neuralgia." (Brisman R, J Neurosurg. 2000 Dec;93 Suppl 3:159-61.) Retrospective. 82 patients with primary GKS treatment vs. 90 patients with GKS as a retreatment. RT dose 75 Gy Pain control: excellent or good result more likely in primary GKS (p=0.058), and not in MS-associated TN (SS). Number and type of procedures NS. Northwest Hospital (Seattle) 2003 ASTRO Abstract -- "Gamma Knife Radiosurgery for Treatment of Trigeminal Neuralgia" (Mehta V, Abstract 21, 2003) Retrospective. 250 patients (no MS-TN, or secondary TN). RT dose 76 Gy, 87 Gy, or 98 Gy. Median f/u 2.4 years Pain control: 6 months - 42% excellent, 33% good. Last f/u - 50% excellent, 14% good. Recurrence in 18%, mean time-to-recurrence 1.8 years (0.5 - 6). At 12 months - 76 Gy 70%, 87 Gy 86%, 98 Gy 86% (trend, but NS) 2000 Abstract 1991-1999 -- "Gamma Knife radiosurgery for treatment of trigeminal neuralgia: long term results" (Young RF, 3rd TN Conference, 2000) Retrospective. 435 patients. RT 76-98 Gy. Median f/u 51 months. 51 patients retreated. Joint with Good Samaritan data?? Pain control: 6 months - 60% excellent, 30% good (some meds). Last f/u - 78% excellent/good. Including retreatment, 65% excellent, 20% good Retreatment: success 80% Side effect: 16% facial numbness 1998 9782251 -- "Gamma knife radiosurgery for the treatment of trigeminal neuralgia." (Young RF, Stereotact Funct Neurosurg. 1998 Oct;70 Suppl 1:192-9.) Retrospective. 110 patients. RT dose 70-80 Gy. Mean f/u 20 months Pain control: Initial relief 95%, 3% recurrence. Atypical TN 88%, 19% recurrence Side effects: 3% sensory 1997 9065534 -- "Gamma Knife radiosurgery for treatment of trigeminal neuralgia: idiopathic and tumor related." (Young RF, Neurology. 1997 Mar;48(3):608-14.) Retrospective. 60 patients. RT 70 Gy. Mean f/u 16.3 months Pain control: 75% excellent, 14% good. Better outcome if no prior surgery. Recurrence 7%. At last follow-up 80% excellent or good result Side effects: 1 patient facial numbness Baylor, 2002 12677104 -- "Gamma knife radiosurgery for treatment of trigeminal neuralgia in multiple sclerosis patients." (Huang E, Stereotact Funct Neurosurg. 2002;79(1):44-50.) Retrospective. 7 patients with MS-associated TN. RT 80-90 Gy. Median f/u 28 months Pain relief: 100% excellent response. Time-to-response 1 day - 8 months. 1/7 recurrence 24 months after treatment Side effects: 4/7 patients persistent numbness in V2 and V3. Arizona Onc Services / Barrow Neurologic Institute 2002 12507090 -- "Gamma knife radiosurgery for trigeminal neuralgia associated with multiple sclerosis." (Rogers CL, J Neurosurg. 2002 Dec;97(5 Suppl):529-32.) Links Retrospective. 15 patients with MS-associated TN. RT 70-90 Gy. Median f/u 17 months Pain relief: 80% some pain relief. Time-to-response 56 days (1-157 days). Retreatment: 5/15 patients, RT dose 48 Gy, same target. All improved Side effects: 2/15 delayed facial hypesthesias after 1st GKS, 2/5 after 2nd GKS. None bothersome. All with hypesthesias had complete pain relief 2000 10863073 1997-99 — "Gamma knife radiosurgery for trigeminal neuralgia: the initial experience of The Barrow Neurological Institute." Rogers CL et al. Int J Radiat Oncol Biol Phys. 2000 Jul 1;47(4):1013-9. 54 pts treated with follow-up of at least 3 months. First 41 treated with 35 Gy to 50% isodose, then 40 Gy for the last 14 pts. Single 4mm shot. Median onset to pain relief, 15 days; to maximal relief, 63 days. 41% able to stop all medications. Mayo 2002 12186463 -- "Stereotactic radiosurgery for idiopathic trigeminal neuralgia." (Pollock BE, J Neurosurg. 2002 Aug;97(2):347-53.) Retrospective. 117 patients. Median f/u 26 months Pain control: excellent 57% at 1 year, 55% at 3 years (actuarial). Greater for previously untreated patients. Side effects: trigeminal dysfunction 37%, bothersome 12%. Strong correlation between facial sensory loss and pain relief 2000 10719853 -- "Stereotactic radiosurgery for tumor-related trigeminal pain." (Pollock BE, Neurosurgery. 2000 Mar;46(3):576-82; discussion 582-3.) Retrospective. 24 patients with cranial base tumors and TN (9) or painful trigeminal neuropathy (15). Radiologic target was tumor. Median f/u 45 months Pain control: 50% initially pain free, 46% significan improvement. 3/24 recurrent pain related to tumor progression 1999 9987527 -- "The Mayo Clinic gamma knife experience: indications and initial results." (Pollock BE, Mayo Clin Proc. 1999 Jan;74(1):5-13.) Links Retrospective. 20 patients with TN, 70% pain free after SRS Comment in Mayo Clin Proc. 1999 Jan;74(1):101-3. Seoul (Korea) 2002 12507091 -- "Unusual causes of trigeminal neuralgia treated by gamma knife radiosurgery. Report of two cases." (Chang JW, J Neurosurg. 2002 Dec;97(5 Suppl):533-5.) Case report. TN caused by lesions along trigeminal nerve within pons, adjacent to 4th ventricle. Postulated old viral neuritis Treated with GKS. Results encouraging so far. 2000 11143233 1992-1995 -- "Gamma knife radiosurgery for idiopathic and secondary trigeminal neuralgia." (Chang JW, J Neurosurg. 2000 Dec;93 Suppl 3:147-51.) Retrospective. 15 patients with idiopathic TN and 38 patients with secondary TN Idiopathic TN: pain control 87%, 2/15 mild sensory change Secondary TN: pain control 67% 1999 10681688 1991-1998 -- "The effects of stereotactic radiosurgery on secondary facial pain." (Chang JW, Stereotact Funct Neurosurg. 1999;72 Suppl 1:29-37.) Retrospective. 27 patients with secondary TN. RT mean dose 26.4 Gy to 45-90% isodose. Mean f/u 32 months Pain control: 86% initial relief, but 50% recurred. Less responsive to SRS than idiopathic TN Alabama, 2002 1995-2001 ASTRO Abstract -- "Radiosurgery for Trigeminal Neuralgia" (Spencer SA, Abstract 2063, 2002) Retrospective. 163 facial pain, 104/113 typical TN. RT 35 Gy to 50% isodose line (36 patients), 40 Gy to 50% isodose line (68 patients). Min f/u 6 months, median f/u 28 months. Pain control: 72% excellent or good. 52% 35 Gy vs. 81% 40 Gy Side effects: 16% paresthesias. 2% 35 Gy vs. 14% 40 Gy. Bothersome 4% Chiba, 2002 (Japan) 12507089 -- "Gamma knife radiosurgery for trigeminal neuralgia: the dry-eye complication." (Matsuda S, J Neurosurg. 2002 Dec;97(5 Suppl):525-8.) Retrospective. 33/41 patients treated with GKS to 80 Gy, 4-mm collimator, single isocenter. Mean f/u 13 months Pain control at last follow up: 49% excellent, 27%. Recurrence 7% Side effects: 17% facial numbness. 3 patients reported "dry eye", with diminution/absence of corneal reflex. No other abnormalities. Marseille (France) 2001 11780888 1992-1997 -- "Long-term outcome after gamma knife surgery for secondary trigeminal neuralgia." (Regis J, J Neurosurg. 2001 Aug;95(2):199-205.) Secondary TN. Median f/u 55 months. Treatment groups as below (Regis, 1998) Neuropathic component poorly sensitive to SRS. 2001 Abstract Régis J, Billet F, Hayashi M: Plexus triangularis gamma knife radiosurgery for trigeminal neuralgia: Results of a 110 patients prospective controlled study. Presented at Symposium on Vascular Interventions, 5th International Stereotactic Radiosurgery Society Congress, Las Vegas, NV, June 10–13, 2001. Goal median dose 90 Gy, but due to blocking brainstem actual average 85 Gy 1999 10099103 -- "Radiosurgery for trigeminal neuralgia and epilepsy." (Regis J, Neurosurg Clin N Am. 1999 Apr;10(2):359-77.) Initial experience with higher doses to 90 Gy Pain control: 90% instead of 65% with original lower doses 1998 9782253 -- "Effect of gamma knife on secondary trigeminal neuralgia." (Regis J, Stereotact Funct Neurosurg. 1998 Oct;70 Suppl 1:210-7.) Retrospective. 53 patients with secondary TN. Four groups (I - essential TN, II - secondary TN with CNV visualized, III - secondary TN with CNV not visualized, IV - goal of tumor control). Groups I/II treated to 70-90 Gy, Groups III/IV treated to 20-40 Gy. Mean f/u 32 months Pain relief: short term 74% excellent, 18% good Side effects: 4% facial hypesthesia, 1 patient motor fasciculation Pittsburgh 2001 11803302 -- "Stereotactic radiosurgery for the treatment of trigeminal neuralgia." (Kondziolka D, Clin J Pain. 2002 Jan-Feb;18(1):42-7.) and 11147887 -- "Clinical outcomes after stereotactic radiosurgery for idiopathic trigeminal neuralgia." (Maesawa S, J Neurosurg. 2001 Jan;94(1):14-20.) Retrospective. 220 patients. RT dose median 80 Gy (60-90 Gy). 16% atypical TN. Median 2 years Pain control: complete or partial in 86% at 1 year, 56% at 5 years. Complete relief in 65% (6 months), 70% (1 year), 75% (2.8 years). Atypical pain had lower rate of pain relief. No prior surgery higher rate of pain relief Side effects: 10% 1998 9782250 -- "Gamma knife radiosurgery as the first surgery for trigeminal neuralgia." (Kondziolka D, Stereotact Funct Neurosurg. 1998 Oct;70 Suppl 1:187-91.) Retrospective. 23 patients. RT 70 Gy (14 patients) or 80 Gy (9 patients). Mean f/u 12 months Pain control: Excellent 74%, good 22% Side effects: None 1998 9865796 -- "Gamma knife radiosurgery for trigeminal neuralgia: results and expectations." (Kondziolka D, Arch Neurol. 1998 Dec;55(12):1524-9.) Retrospective. 106 patients. RT dose 70-90 Gy. Median f/u 18 months Pain control: Initial 60% excellent, 17% good. Last follow-up 77% excellent + good. Dose, age, prior surgery, sensory loss didn't correlate with outcome. 10% recurrence Side effects: paresthesias 10% 1996 9032878 -- "Trigeminal neuralgia radiosurgery: the University of Pittsburgh experience." (Kondziolka D, Stereotact Funct Neurosurg. 1996;66 Suppl 1:343-8.) Retrospective. 51 patients with typical TN. RT dose 60-90 Gy. 86% prior surgery. Mean f/u 10 months Pain control: Initial 86% response. Last follow-up 37% excellent, 41% good, 21% failed RT dose >=70 Gy associated with significantly greater chance for complete pain relief Tianjin, 2001 (China) 1996-1999 12007276 -- "Stereotactic radiosurgery for primary trigeminal neuralgia using the Leksell Gamma unit." (Zheng LG, Stereotact Funct Neurosurg. 2001;76(1):29-35.) Retrospective. 80 patients. RT dose mean 75.6 Gy (70-90 Gy). Follow-up 24 months Pain control: excellent 52%, good 31%, fair 10%, fail 6%. Mean time to improvement 22 days (1-120 days). Recurrence 10% in 5-26 months later Retreatment: 12 patients (7 recurrent, 5 failures). RT dose mean 74.2 Gy (70-80 Gy). Mean f/u 18 months, 9/12 excellent result, 2/12 good result, 1 failed. Mean time to improvement 15 days (1-120) Side effects: 11% facial numbness Yale, 2001 1998-1999 ASTRO Abstract -- "Gamma Knife Radiosurgery for the Treatment of Trigeminal Neuralgia: Early Results of the Yale Experience" (Kim DH, Abstract 107, 2001) Retrospective. 54 cases, idiopathic or MS-TN. RT dose 80 Gy. Median f/u 1.1 years Pain control: 98% response, 85% decreased meds. Recurrence 32% at 60 weeks actuarial, 24% if CR Side effects: 13% hypesthesia, 4% decreased corneal sensation, 4% paresthesias Kentucky, 2000 11143234 -- "Gamma knife radiosurgery using 90 Gy for trigeminal neuralgia." (Nicol B, J Neurosurg. 2000 Dec;93 Suppl 3:152-4.) Retrospective. 42 patients treated to 90 Gy. Median f/u 14 months Pain control: 74% complete, 21% good . Side effects: paresthesia 17%, dysgeusia 10% Cleveland Clinic, 2000 ASTRO Abstract 1997-1999 "Results of gamma knife radiosurgery for trigeminal neuralgia" (Suh JH, Abstract 264, 2000) Retrospective. 55/95 patients, phone survey. 22% TN-MS. RT dose 75 Gy Pain control: 65% BNI I/II, 27% BNI III Side effects: mild numbness 11% Mumbai, 1999 (India) 10901930 -- "Gamma-knife radiosurgery for trigeminal neuralgia." (Kannan V, Australas Radiol. 1999 Aug;43(3):339-41.) Retrospective. 7 patient treated. RT 70-80 Gy. Follow up 5-16 months Pain control: complete 4/7, partial 2/7. No side effects UCLA, 1997 9018707 -- "Leksell Gamma Knife treatment of tic douloureux." (Rand RW, Neurosurg Clin N Am. 1997 Jan;8(1):75-8.) Retrospective. 12 patients. F/u 3-4 years Pain control: 8/12 improvement or complete relief. Side effects: 1 radionecrosis in medial temporal lobe Good Samaritan LA, 1996 1991-1995 ASTRO Abstract "Intractable Trigeminal Neuralgia: A Single Institution Experience in 26 Patients Treated With Stereotactic Gamma Knife Radiosurgery" (Rufus JM, Abstract 71, 1996) Retrospective. 26 patients. RT 64.3 - 70 Gy, 1 patients 120 Gy. Median f/u 19 months Pain control: Last follow-up - 42% excellent, 42% good (>50% reduction). Dose response: <70 Gy 25% CR, 70 Gy 57% CR Side effects: 8% (1 patient numbness, 1 patient temporal lobe edema, resolved after decadron) Multi-institutional, 1996 8847587 -- "Stereotactic radiosurgery for trigeminal neuralgia: a multiinstitutional study using the gamma unit." (Kondziolka D, J Neurosurg. 1996 Jun;84(6):940-5.) 5 institutions (Pittsburgh, Northwest Hospital, Good Samaritan Hospital, Marseille, Brown). 50 patients. RT dose 60-90 Gy. Median f/u 18 months Pain control: 58% excellent, 36% good (50-90%), 6% failure. Time to pain relief 1 month (1 day - 6.7 months). 6% recurrence. At 2 years 54% pain-free, 88% good relief RT: dose >=70 Gy with significantly greater chance of complete relief (72% vs. 9%) Side effects: 6% facial paresthesias Marseille, 1995 (France) 8584826 -- "Effect of the Gamma Knife on trigeminal neuralgia." (Regis J, Stereotact Funct Neurosurg. 1995;64 Suppl 1:182-92.) Initial report. 20 patients with TN, 11 with goal of pain relief, 9 with tumor control Appear to have rapid clinical improvement and great benefit Karolinksa, 1971 (Sweden) 4948331 -- "Sterotaxic radiosurgery in trigeminal neuralgia." (Leksell L, Acta Chir Scand. 1971;137(4):311-4.)