Abstract | PURPOSE: METHODS AND MATERIALS: We conducted a retrospective review of 200 patients undergoing Gamma Knife (Elekta Instrument AB, Stockholm, Sweden) stereotactic radiosurgery for trigeminal neuralgia between February 1995 and May 2008. We selected patients treated with a maximum dose of 80 Gy with 4-mm diameter collimators, with no previous microvascular decompression, and follow-up ≥6 months (median, 24 months; range, 6-153 months). At the time of radiosurgery, 28 patients were taking no anticonvulsants, 62 only carbamazepine, 35 only gabapentin, 21 carbamazepine plus gabapentin, 17 carbamazepine plus other anticonvulsants, and 9 gabapentin plus other anticonvulsants, and 28 were taking other anticonvulsants or combinations. RESULTS:
Pain improvement developed post-radiosurgery in 187 of 200 patients (93.5%). Initial complete pain relief developed in 84 of 200 patients (42%). Post-radiosurgery trigeminal neuropathy developed in 27 of 200 patients (13.5%). We could not significantly correlate pain improvement or initial complete pain relief with use of carbamazepine, gabapentin, or use of any anticonvulsants/ neuroleptic drugs or other factors in univariate or multivariate analysis. Post-radiosurgery numbness/ paresthesias correlated with the use of gabapentin (1 of 36 patients with gabapentin vs. 7 of 28 without, p = 0.017). In multivariate analysis, decreasing age, purely typical pain, and use of gabapentin correlated (p = 0.008, p = 0.005, and p = 0.021) with lower risks of developing post-radiosurgery trigeminal neuropathy. New post-radiosurgery numbness/ paresthesias developed in 3% (1 of 36), 5% (4 of 81), and 13% (23 of 187) of patients on gabapentin alone, with age ≤70 years, and Type 1 typical trigeminal neuralgia pain compared with 25% (7 of 28), 20% (23 of 114), and 33% (4 of 12) of patients taking no anticonvulsants, age >70 years, and partly atypical Type 2 trigeminal neuralgia, respectively. CONCLUSIONS:
|
Authors | John C Flickinger Jr, Hyun Kim, Hideyuki Kano, Joel S Greenberger, Yoshio Arai, Ajay Niranjan, L Dade Lunsford, Douglas Kondziolka, John C Flickinger Sr |
Journal | International journal of radiation oncology, biology, physics
(Int J Radiat Oncol Biol Phys)
Vol. 83
Issue 4
Pg. e501-6
(Jul 15 2012)
ISSN: 1879-355X [Electronic] United States |
PMID | 22417801
(Publication Type: Journal Article)
|
Copyright | Copyright © 2012 Elsevier Inc. All rights reserved. |
Chemical References |
- Amines
- Anticonvulsants
- Cyclohexanecarboxylic Acids
- Radiation-Protective Agents
- Carbamazepine
- gamma-Aminobutyric Acid
- Gabapentin
|
Topics |
- Adult
- Aged
- Aged, 80 and over
- Amines
(pharmacology)
- Analysis of Variance
- Anticonvulsants
(pharmacology)
- Carbamazepine
(pharmacology)
- Cyclohexanecarboxylic Acids
(pharmacology)
- Female
- Gabapentin
- Humans
- Male
- Middle Aged
- Radiation-Protective Agents
(pharmacology)
- Radiosurgery
(adverse effects, methods)
- Radiotherapy Dosage
- Retrospective Studies
- Trigeminal Neuralgia
(etiology, surgery)
- gamma-Aminobutyric Acid
(pharmacology)
|