Abstract | BACKGROUND: Surgical options for multiple sclerosis (MS) related to trigeminal neuralgia (TN), a severe and disabling pain disorder, include percutaneous rhizotomy, stereotactic radiosurgery, or microsurgical nerve section. Our goal was to evaluate clinical outcomes after gamma knife radiosurgery (GKRS) in patients with MS with TN. METHODS: We evaluated clinical outcomes in 37 patients with TN managed over a 12-year period. The maximum TN target dose varied between 70 and 90 Gy. Seventy-eight percent of patients had failed prior surgery. In 9, GKRS was the first procedure. Median follow-up was 56.7 months (range, 6-174). Pain relief was assessed in each patient by physicians who did not participate in the surgery. RESULTS: Eventual complete pain relief (BNI grade I) after GKRS and reasonable pain control (BNI grade I-IIIb) after GKRS were noted in 23 patients (62.1%) and 36 patients (97.3%) at some point in their course. Reasonable pain control (BNI grade I-IIIb) after GKRS was maintained in 82.6%, 73.9%, and 54.0% of patients after 1, 3, and 5 years. Fourteen patients (37.8%) underwent a second or a subsequent procedure for residual or recurrent pain. Eight patients underwent a second GKRS, 5 underwent percutaneous glycerol rhizotomy, and 1 underwent balloon microcompression. The complication rate after GKRS was 5.4% (new onset of nondisabling paresthesias). No patient developed dysesthesias. CONCLUSIONS:
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Authors | O Zorro, J Lobato-Polo, H Kano, J C Flickinger, L D Lunsford, D Kondziolka |
Journal | Neurology
(Neurology)
Vol. 73
Issue 14
Pg. 1149-54
(Oct 06 2009)
ISSN: 1526-632X [Electronic] United States |
PMID | 19805732
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Topics |
- Adult
- Aged
- Facial Pain
(etiology, prevention & control)
- Female
- Humans
- Kaplan-Meier Estimate
- Male
- Middle Aged
- Multiple Sclerosis
(complications)
- Pain Measurement
- Quality of Life
- Radiosurgery
(methods)
- Severity of Illness Index
- Treatment Outcome
- Trigeminal Neuralgia
(etiology, surgery)
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