Abstract
Purpose: A variety of treatment plans including an array of prescription doses have been used in radiosurgery treatment of trigeminal neuralgia (TN). However, despite a considerable experience in the radiosurgical treatment of TN, an ideal prescription dose that balances facial dysesthesia risk with pain relief durability has not been determined. Methods and Materials: This retrospective study of patients treated with radiosurgery for typical TN evaluates two treatment doses in relation to outcomes of pain freedom, bothersome facial numbness, and patient satisfaction with treatment. All patients were treated with radiosurgery for intractable and disabling TN. A treatment dose protocol change from 80 to 85 Gy provided an opportunity to compare two prescription doses. The variables evaluated were pain relief, treatment side-effect profile, and patient satisfaction. Results: Typical TN was treated with 80 Gy in 26 patients, and 85 Gy in 37 patients. A new face sensory disturbance was reported after 80 Gy in 16% and after 85 Gy in 27% (p = 0.4). Thirteen failed an 80 Gy dose whereas seven failed an 85 Gy dose. Kaplan–Meier analysis found that at 29 months 50% failed an 80 Gy treatment compared with 79% who had durable pain relief after 85 Gy treatment (p = 0.04). Conclusion: The 85 Gy dose for TN provided a more durable pain relief compared to the 80 Gy one without a significantly elevated occurrence of facial sensory disturbance.
Highlights
Trigeminal neuralgia (TN) is a chronic neuropathic pain condition that affects the regions of the face innervated by the trigeminal nerve
The mean follow-up after Gamma Knife radiosurgery (GKR) in pain free patients was 37 months in individuals treated with 80 Gy and 26 months in patients treated with 85 Gy
Kondziolka et al identified that patients who received a 70 Gy dose for treatment of trigeminal neuralgia (TN) fared better with improved pain relief compared to lower prescription doses, and complications were rare [5]
Summary
Trigeminal neuralgia (TN) is a chronic neuropathic pain condition that affects the regions of the face innervated by the trigeminal nerve. Typical TN causes severe and sudden volleys of shock-like facial pain that lasts a few seconds to a few minutes in the distribution of one or more divisions of the trigeminal nerve. When patients experience attacks of pain that come on repeatedly, the result is a pain condition that is disabling in nature. Typical TN will have a trigger in the trigeminal nerve division distribution the pain is felt in, which often leads to aversive behavior by the patient to avoid the pain. Atypical forms of face pain have symptoms that are not shock-like in nature, do not follow the trigeminal nerve distribution, and/or do not have an associated trigger. Atypical face pain my certainly be disabling in nature, the treatment options available to typical TN patients are less likely to benefit individuals with atypical face pain
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