Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Gamma Knife Radiosurgery for Trigeminal Neuralgia : Review and Update

  • Lee, Seunghoon (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Jung-Il (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2021.12.08
  • Accepted : 2022.06.27
  • Published : 2022.09.01
Download PDF
⟨ Previous Next ⟩

Abstract

Accurate diagnosis of trigeminal neuralgia (TN) is the starting point for optimal treatment. Gamma knife radiosurgery (GKRS) is currently regarded as one of the first-line treatment options for medically refractory TN. GKRS is a less invasive treatment with a low risk of complications than other surgical procedures that provides a favorable pain control Barrow Neurological Institute (BNI) I-IIIb rate of >75% at short-term follow-up. Drawbacks of GKRS include the latency period before pain relief and higher recurrence rate compared with microvascular decompression. Therefore, repeat treatment is necessary if the initial GKRS was effective but followed by recurrence. The concept of dose rate and the biologically effective dose of radiation has been actively studied in radiation oncology and is also applied in GKRS for TN to achieve high safety and efficacy by prescribing the optimal dose. Recent progress in functional imaging, such as diffusion tensor imaging, enables us to understand the pathophysiology of TN and predict the clinical outcome after GKRS. Here, we review TN, GKRS, and recent updates, especially in the concepts of radiation dose, diffusion tensor imaging studies, and repeat treatment in GKRS for TN.

Keywords

References

  1. Alexander AL, Lee JE, Lazar M, Field AS : Diffusion tensor imaging of the brain. Neurotherapeutics 4 : 316-329, 2007 https://doi.org/10.1016/j.nurt.2007.05.011
  2. Alpert TE, Chung CT, Mitchell LT, Hodge CJ, Montgomery CT, Bogart JA, et al. : Gamma knife surgery for trigeminal neuralgia: improved initial response with two isocenters and increasing dose. J Neurosurg 102 Suppl : 185-188, 2005 https://doi.org/10.3171/sup.2005.102.s_supplement.0185
  3. Arai Y, Kano H, Lunsford LD, Novotny J Jr, Niranjan A, Flickinger JC, et al. : Does the Gamma Knife dose rate affect outcomes in radiosurgery for trigeminal neuralgia? J Neurosurg 113 Suppl : 168-171, 2010 https://doi.org/10.3171/2010.7.GKS101049
  4. Aubuchon AC, Chan MD, Lovato JF, Balamucki CJ, Ellis TL, Tatter SB, et al. : Repeat gamma knife radiosurgery for trigeminal neuralgia. Int J Radiat Oncol Biol Phys 81 : 1059-1065, 2011 https://doi.org/10.1016/j.ijrobp.2010.07.010
  5. Balamucki CJ, Stieber VW, Ellis TL, Tatter SB, Deguzman AF, McMullen KP, et al. : Does dose rate affect efficacy? The outcomes of 256 gamma knife surgery procedures for trigeminal neuralgia and other types of facial pain as they relate to the half-life of cobalt. J Neurosurg 105 : 730-735, 2006 https://doi.org/10.3171/jns.2006.105.5.730
  6. Barker FG 2nd, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD : The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334 : 1077-1083, 1996 https://doi.org/10.1056/NEJM199604253341701
  7. Barzaghi LR, Albano L, Scudieri C, Gigliotti CR, Del Vecchio A, Mortini P : Factors affecting long-lasting pain relief after Gamma knife radiosurgery for trigeminal neuralgia: a single institutional analysis and literature review. Neurosurg Rev 44 : 2797-2808, 2021 https://doi.org/10.1007/s10143-021-01474-9
  8. Baschnagel AM, Cartier JL, Dreyer J, Chen PY, Pieper DR, Olson RE, et al. : Trigeminal neuralgia pain relief after gamma knife stereotactic radiosurgery. Clin Neurol Neurosurg 117 : 107-111, 2014 https://doi.org/10.1016/j.clineuro.2013.12.003
  9. Behan B, Chen DQ, Sammartino F, DeSouza DD, Wharton-Shukster E, Hodaie M : Comparison of diffusion-weighted MRI reconstruction methods for visualization of cranial nerves in posterior fossa surgery. Front Neurosci 11 : 554, 2017
  10. Brisman R : Repeat gamma knife radiosurgery for trigeminal neuralgia. Stereotact Funct Neurosurg 81 : 43-49, 2003 https://doi.org/10.1159/000075103
  11. Chen DQ, DeSouza DD, Hayes DJ, Davis KD, O'Connor P, Hodaie M : Diffusivity signatures characterize trigeminal neuralgia associated with multiple sclerosis. Mult Scler 22 : 51-63, 2016 https://doi.org/10.1177/1352458515579440
  12. Danyluk H, Sankar T, Beaulieu C : High spatial resolution nerve-specific DTI protocol outperforms whole-brain DTI protocol for imaging the trigeminal nerve in healthy individuals. NMR Biomed 34 : e4427, 2021
  13. DeSouza DD, Hodaie M, Davis KD : Abnormal trigeminal nerve microstructure and brain white matter in idiopathic trigeminal neuralgia. Pain 155 : 37-44, 2014 https://doi.org/10.1016/j.pain.2013.08.029
  14. Dhople AA, Adams JR, Maggio WW, Naqvi SA, Regine WF, Kwok Y : Long-term outcomes of Gamma knife radiosurgery for classic trigeminal neuralgia: implications of treatment and critical review of the literature. Clinical article. J Neurosurg 111 : 351-358, 2009 https://doi.org/10.3171/2009.2.JNS08977
  15. Dvorak T, Finn A, Price LL, Mignano JE, Fitzek MM, Wu JK, et al. : Retreatment of trigeminal neuralgia with Gamma knife radiosurgery: is there an appropriate cumulative dose? Clinical article. J Neurosurg 111 : 359-364, 2009 https://doi.org/10.3171/2008.11.JNS08770
  16. Erbay SH, Bhadelia RA, Riesenburger R, Gupta P, O'Callaghan M, Yun E, et al. : Association between neurovascular contact on MRI and response to Gamma knife radiosurgery in trigeminal neuralgia. Neuroradiology 48 : 26-30, 2006 https://doi.org/10.1007/s00234-005-0008-5
  17. Flickinger JC, Pollock BE, Kondziolka D, Phuong LK, Foote RL, Stafford SL, et al. : Does increased nerve length within the treatment volume improve trigeminal neuralgia radiosurgery? A prospective double-blind, randomized study. Int J Radiat Oncol Biol Phys 51 : 449-454, 2001 https://doi.org/10.1016/S0360-3016(01)01606-6
  18. Fountas KN, Lee GP, Smith JR : Outcome of patients undergoing gamma knife stereotactic radiosurgery for medically refractory idiopathic trigeminal neuralgia: Medical College of Georgia's experience. Stereotact Funct Neurosurg 84 : 88-96, 2006 https://doi.org/10.1159/000094366
  19. Gellner V, Kurschel S, Kreil W, Holl EM, Ofner-Kopeinig P, Unger F : Recurrent trigeminal neuralgia: long term outcome of repeat Gamma knife radiosurgery. J Neurol Neurosurg Psychiatry 79 : 1405-1407, 2008 https://doi.org/10.1136/jnnp.2007.142794
  20. Hasegawa T, Kondziolka D, Spiro R, Flickinger JC, Lunsford LD : Repeat radiosurgery for refractory trigeminal neuralgia. Neurosurgery 50 : 494-500; discussion 500-502, 2002
  21. Helis CA, Hughes RT, Munley MT, Bourland JD, Jacobson T, Lucas JT, et al. : Results of a third Gamma knife radiosurgery for trigeminal neuralgia. J Neurosurg 134 : 1237-1243, 2020
  22. Helis CA, Lucas JT Jr, Bourland JD, Chan MD, Tatter SB, Laxton AW : Repeat radiosurgery for trigeminal neuralgia. Neurosurgery 77 : 755-761; discussion 761, 2015 https://doi.org/10.1227/NEU.0000000000000915
  23. Herman JM, Petit JH, Amin P, Kwok Y, Dutta PR, Chin LS : Repeat gamma knife radiosurgery for refractory or recurrent trigeminal neuralgia: treatment outcomes and quality-of-life assessment. Int J Radiat Oncol Biol Phys 59 : 112-116, 2004 https://doi.org/10.1016/j.ijrobp.2003.10.041
  24. Herweh C, Kress B, Rasche D, Tronnier V, Troger J, Sartor K, et al. : Loss of anisotropy in trigeminal neuralgia revealed by diffusion tensor imaging. Neurology 68 : 776-778, 2007 https://doi.org/10.1212/01.wnl.0000256340.16766.1d
  25. Hodaie M, Chen DQ, Quan J, Laperriere N : Tractography delineates microstructural changes in the trigeminal nerve after focal radiosurgery for trigeminal neuralgia. PLoS One 7 : e32745, 2012
  26. Huang CF, Chuang JC, Tu HT, Chou MC : Microsurgical outcomes after failed repeated Gamma Knife surgery for refractory trigeminal neuralgia. J Neurosurg 105 Suppl : 117-119, 2006 https://doi.org/10.3171/sup.2006.105.7.117
  27. Hung PS, Chen DQ, Davis KD, Zhong J, Hodaie M : Predicting pain relief: use of pre-surgical trigeminal nerve diffusion metrics in trigeminal neuralgia. Neuroimage Clin 15 : 710-718, 2017 https://doi.org/10.1016/j.nicl.2017.06.017
  28. Hung PS, Tohyama S, Zhang JY, Hodaie M : Temporal disconnection between pain relief and trigeminal nerve microstructural changes after Gamma knife radiosurgery for trigeminal neuralgia. J Neurosurg 133 : 727-735, 2019
  29. Kim YH, Kim DG, Kim JW, Kim YH, Han JH, Chung HT, et al. : Is it effective to raise the irradiation dose from 80 to 85 Gy in Gamma knife radiosurgery for trigeminal neuralgia? Stereotact Funct Neurosurg 88 : 169-176, 2010 https://doi.org/10.1159/000313869
  30. Kimball BY, Sorenson JM, Cunningham D : Repeat Gamma knife surgery for trigeminal neuralgia: long-term results. J Neurosurg 113 Suppl : 178-183, 2010 https://doi.org/10.3171/2010.8.GKS101075
  31. Kondziolka D, Flickinger JC, Lunsford LD, Habeck M : Trigeminal neuralgia radiosurgery: the University of Pittsburgh experience. Stereotact Funct Neurosurg 66 Suppl 1 : 343-348, 1996 https://doi.org/10.1159/000099734
  32. Kondziolka D, Lunsford LD, Flickinger JC, Young RF, Vermeulen S, Duma CM, et al. : Stereotactic radiosurgery for trigeminal neuralgia: a multi-institutional study using the gamma unit. J Neurosurg 84 : 940-945, 1996 https://doi.org/10.3171/jns.1996.84.6.0940
  33. Kondziolka D, Zorro O, Lobato-Polo J, Kano H, Flannery TJ, Flickinger JC, et al. : Gamma knife stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 112 : 758-765, 2010 https://doi.org/10.3171/2009.7.JNS09694
  34. Leal PRL, Roch JA, Hermier M, Souza MAN, Cristino-Filho G, Sindou M : Structural abnormalities of the trigeminal root revealed by diffusion tensor imaging in patients with trigeminal neuralgia caused by neurovascular compression: a prospective, double-blind, controlled study. Pain 152 : 2357-2364, 2011 https://doi.org/10.1016/j.pain.2011.06.029
  35. Lee JY, Sandhu S, Miller D, Solberg T, Dorsey JF, Alonso-Basanta M : Higher dose rate Gamma knife radiosurgery may provide earlier and longer-lasting pain relief for patients with trigeminal neuralgia. J Neurosurg 123 : 961-968, 2015 https://doi.org/10.3171/2014.12.JNS142013
  36. Leksell L : The stereotaxic method and radiosurgery of the brain. Acta Chir Scand 102 : 316-319, 1951
  37. Lindquist C, Kihlstrom L, Hellstrand E : Functional neurosurgery--a future for the Gamma knife? Stereotact Funct Neurosurg 57 : 72-81, 1991 https://doi.org/10.1159/000099557
  38. Linskey ME, Ratanatharathorn V, Penagaricano J : A prospective cohort study of microvascular decompression and Gamma knife surgery in patients with trigeminal neuralgia. J Neurosurg 109 Suppl : 160-172, 2008 https://doi.org/10.3171/JNS/2008/109/12/S25
  39. Longhi M, Rizzo P, Nicolato A, Foroni R, Reggio M, Gerosa M : Gamma knife radiosurgery for trigeminal neuralgia: results and potentially predictive parameters--part I: idiopathic trigeminal neuralgia. Neurosurgery 61 : 1254-1260; discussion 1260-1261, 2007
  40. Lucas JT Jr, Nida AM, Isom S, Marshall K, Bourland JD, Laxton AW, et al. : Predictive nomogram for the durability of pain relief from Gamma knife radiation surgery in the treatment of trigeminal neuralgia. Int J Radiat Oncol Biol Phys 89 : 120-126, 2014 https://doi.org/10.1016/j.ijrobp.2014.01.023
  41. Marshall K, Chan MD, McCoy TP, Aubuchon AC, Bourland JD, McMullen KP, et al. : Predictive variables for the successful treatment of trigeminal neuralgia with gamma knife radiosurgery. Neurosurgery 70 : 566-572; discussion 572-573, 2012
  42. Matsuda S, Serizawa T, Nagano O, Ono J : Comparison of the results of 2 targeting methods in Gamma Knife surgery for trigeminal neuralgia. J Neurosurg 109 Suppl : 185-189, 2008 https://doi.org/10.3171/JNS/2008/109/12/S28
  43. Mendelson ZS, Velagala JR, Kohli G, Heir GM, Mammis A, Liu JK : Pain-free outcomes and durability of surgical intervention for trigeminal neuralgia: a comparison of gamma knife and microvascular decompression. World Neurosurg 112 : e732-e746, 2018 https://doi.org/10.1016/j.wneu.2018.01.141
  44. O'Donnell LJ, Westin CF : An introduction to diffusion tensor image analysis. Neurosurg Clin N Am 22 : 185-196, viii, 2011 https://doi.org/10.1016/j.nec.2010.12.004
  45. Omar NB, Amburgy JW, Self DM, Christen AM, Larios EA, Ditty BJ, et al. : Repeat gamma knife stereotactic radiosurgery in the treatment of trigeminal neuralgia: a single-center experience and focused review of the literature. J Clin Neurosci 70 : 102-107, 2019 https://doi.org/10.1016/j.jocn.2019.08.061
  46. Park KJ, Kondziolka D, Berkowitz O, Kano H, Novotny J Jr, Niranjan A, et al. : Repeat gamma knife radiosurgery for trigeminal neuralgia. Neurosurgery 70 : 295-305; discussion 305, 2012 https://doi.org/10.1227/NEU.0b013e318230218e
  47. Park SH, Hwang SK, Kang DH, Park J, Hwang JH, Sung JK : The retrogasserian zone versus dorsal root entry zone: comparison of two targeting techniques of Gamma knife radiosurgery for trigeminal neuralgia. Acta Neurochir (Wien) 152 : 1165-1170, 2010 https://doi.org/10.1007/s00701-010-0610-0
  48. Pollock BE, Foote RL, Link MJ, Stafford SL, Brown PD, Schomberg PJ : Repeat radiosurgery for idiopathic trigeminal neuralgia. Int J Radiat Oncol Biol Phys 61 : 192-195, 2005 https://doi.org/10.1016/j.ijrobp.2004.03.019
  49. Pollock BE, Foote RL, Stafford SL, Link MJ, Gorman DA, Schomberg PJ : Results of repeated gamma knife radiosurgery for medically unresponsive trigeminal neuralgia. J Neurosurg 93 Suppl 3 : 162-164, 2000 https://doi.org/10.3171/jns.2000.93.supplement_3.0162
  50. Pollock BE, Phuong LK, Gorman DA, Foote RL, Stafford SL : Stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 97 : 347-353, 2002 https://doi.org/10.3171/jns.2002.97.2.0347
  51. Rand RW, Jacques DB, Melbye RW, Copcutt BG, Levenick MN, Fisher MR : Leksell Gamma knife treatment of tic douloureux. Stereotact Funct Neurosurg 61 Suppl 1 : 93-102, 1993 https://doi.org/10.1159/000100663
  52. Regis J, Tuleasca C, Resseguier N, Carron R, Donnet A, Gaudart J, et al. : Long-term safety and efficacy of Gamma knife surgery in classical trigeminal neuralgia: a 497-patient historical cohort study. J Neurosurg 124 : 1079-1087, 2016 https://doi.org/10.3171/2015.2.JNS142144
  53. Regis J, Tuleasca C, Resseguier N, Carron R, Donnet A, Yomo S, et al. : The very long-term outcome of radiosurgery for classical trigeminal neuralgia. Stereotact Funct Neurosurg 94 : 24-32, 2016 https://doi.org/10.1159/000443529
  54. Shaya M, Jawahar A, Caldito G, Sin A, Willis BK, Nanda A : Gamma knife radiosurgery for trigeminal neuralgia: a study of predictors of success, efficacy, safety, and outcome at LSUHSC. Surg Neurol 61 : 529-534; discussion 534-535, 2004 https://doi.org/10.1016/j.surneu.2003.11.028
  55. Sheehan J, Pan HC, Stroila M, Steiner L : Gamma knife surgery for trigeminal neuralgia: outcomes and prognostic factors. J Neurosurg 102 : 434-441, 2005 https://doi.org/10.3171/jns.2005.102.3.0434
  56. Shetter AG, Rogers CL, Ponce F, Fiedler JA, Smith K, Speiser BL : Gamma knife radiosurgery for recurrent trigeminal neuralgia. J Neurosurg 97(5 Suppl) : 536-538, 2002 https://doi.org/10.3171/jns.2002.97.supplement_5.0536
  57. Smith DR, Saadatmand HJ, Wu CC, Black PJ, Wuu YR, Lesser J, et al. : Treatment outcomes and dose rate effects following Gamma knife stereotactic radiosurgery for vestibular schwannomas. Neurosurgery 85 : E1084-E1094, 2019 https://doi.org/10.1093/neuros/nyz229
  58. Song SK, Sun SW, Ju WK, Lin SJ, Cross AH, Neufeld AH : Diffusion tensor imaging detects and differentiates axon and myelin degeneration in mouse optic nerve after retinal ischemia. Neuroimage 20 : 1714-1722, 2003 https://doi.org/10.1016/j.neuroimage.2003.07.005
  59. Song SK, Sun SW, Ramsbottom MJ, Chang C, Russell J, Cross AH : Dysmyelination revealed through MRI as increased radial (but unchanged axial) diffusion of water. Neuroimage 17 : 1429-1436, 2002 https://doi.org/10.1006/nimg.2002.1267
  60. Song SK, Yoshino J, Le TQ, Lin SJ, Sun SW, Cross AH, et al. : Demyelination increases radial diffusivity in corpus callosum of mouse brain. Neuroimage 26 : 132-140, 2005 https://doi.org/10.1016/j.neuroimage.2005.01.028
  61. Tempel ZJ, Chivukula S, Monaco EA 3rd, Bowden G, Kano H, Niranjan A, et al. : The results of a third Gamma knife procedure for recurrent trigeminal neuralgia. J Neurosurg 122 : 169-179, 2015 https://doi.org/10.3171/2014.9.JNS132779
  62. Tohyama S, Walker MR, Zhang JY, Cheng JC, Hodaie M : Brainstem trigeminal fiber microstructural abnormalities are associated with treatment response across subtypes of trigeminal neuralgia. Pain 162 : 1790-1799, 2021 https://doi.org/10.1097/j.pain.0000000000002164
  63. Tuleasca C, Paddick I, Hopewell JW, Jones B, Millar WT, Hamdi H, et al. : Establishment of a therapeutic ratio for Gamma knife radiosurgery of trigeminal neuralgia: the critical importance of biologically effective dose versus physical dose. World Neurosurg 134 : e204-e213, 2020 https://doi.org/10.1016/j.wneu.2019.10.021
  64. Tuleasca C, Regis J, Sahgal A, De Salles A, Hayashi M, Ma L, et al. : Stereotactic radiosurgery for trigeminal neuralgia: a systematic review. J Neurosurg 130 : 733-757, 2018
  65. Wang DD, Raygor KP, Cage TA, Ward MM, Westcott S, Barbaro NM, et al. : Prospective comparison of long-term pain relief rates after first-time microvascular decompression and stereotactic radiosurgery for trigeminal neuralgia. J Neurosurg 128 : 68-77, 2018 https://doi.org/10.3171/2016.9.JNS16149
  66. Wang JY, Bender MT, Bettegowda C: Percutaneous procedures for the treatment of trigeminal neuralgia. Neurosurg Clin N Am 27 : 277-295, 2016 https://doi.org/10.1016/j.nec.2016.02.005
  67. Xu Z, Schlesinger D, Moldovan K, Przybylowski C, Sun X, Lee CC, et al. : Impact of target location on the response of trigeminal neuralgia to stereotactic radiosurgery. J Neurosurg 120 : 716-724, 2014 https://doi.org/10.3171/2013.10.JNS131596
  68. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 38 : 1-211, 2018