Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Anatomical Considerations in Gamma Knife Radiosurgery for Idiopathic Trigeminal Neuralgia

  • Kim, Young-Hoon (Departments of Neurosurgery, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital) ;
  • Park, Chul-Kee (Departments of Neurosurgery, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital) ;
  • Chung, Hyun-Tai (Departments of Neurosurgery, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital) ;
  • Paek, Sun-Ha (Departments of Neurosurgery, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital) ;
  • Kim, Dong-Gyu (Departments of Neurosurgery, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital)
  • Published : 2006.09.30
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Abstract

Objective : The authors conducted this study to present the long-term treatment outcomes [minimum 2 years] of Gamma knife radiosurgery[GKS] for trigeminal neuralgia[TN] and to demonstrate the correlation of treatment outcomes and the anatomical characteristics of TN. Methods : From 1997 to 2003, 44 consecutive patients suffering from medically intractable pain underwent GKS for TN. A single 4mm collimator was used with a median maximum dose of 80Gy [range $75{\sim}80Gy$] prescribed to the root entry zone of the trigeminal nerve. Median follow up duration was 30 months [range $24{\sim}78\;months$]. Anatomical measurements of trigeminal nerve in magnetic resonance images during GKS planning were correlated with clinical outcome. Results : Twenty-two patients [50%] achieved an excellent outcome [BNI grade I & II], 20 patients [45.5%] a good outcome [grade IIIa & IIIb], and only 2 patients [4.5%] a poor outcome [grade IV & V]. Eleven patients [25.0%] experienced pain recurrence after initial pain relief. Smaller volume of trigeminal nerve area irradiated more than 40Gy was significantly correlated with excellent outcome in both univariate and multivariate analyses respectively [P=0.033 and 0.040]. Conclusion : Anatomical considerations during the planning of GKS would be helpful for predicting clinical outcome in TN.

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References

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