Trigeminal neuralgia related to megadolichobasilar artery compression: a prospective series of twenty-nine patients treated with gamma knife surgery, with more than one year of follow-up.

Abstract

BACKGROUND:

Trigeminal neuralgia (TN) secondary to megadolichobasilar artery (MBA) compression is considerably difficult to manage surgically.

OBJECTIVE:

This study aims to evaluate the safety/efficacy of Gamma Knife surgery (GKS) in this special group of patients.

METHODS:

Between July 1992 and November 2010, 29 patients with >1 year of follow-up presenting with MBA compression were treated with GKS at Timone University Hospital. Radiosurgery was performed using a Gamma Knife (model B, C or Perfexion). A single 4-mm isocenter was positioned in the cisternal portion of the trigeminal nerve at a median distance of 9.1 mm (range: 6-18.2 mm) from the emergence.

RESULTS:

The median follow-up period was 46.1 months (range: 12.9-157.9 months). Initially, all patients (100%) were pain free; the average time to complete pain relief was 13.5 days (range: 0-240 days). Their actuarial probability of remaining pain free without medication at 0.5, 1 and 2 years was 93.1, 79.3 and 75.7%, respectively, and remained stable until 13 years after treatment. The actuarial probability of hypoesthesia onset at 6 months was 4.3%; at 1 year it reached 13% and remained stable until 13 years after treatment.

CONCLUSIONS:

GKS proved to be reasonably safe and effective on a long-term basis as a first- and/or second-line surgical treatment for TN due to MBA compression.

• Authors: Constantin Tuleasca, Romain Carron, Noémie Resseguier, Anne Donnet, Philippe Roussel, Jean Gaudart, Marc Levivier, Jean Régis
• Journal: Stereotactic and functional neurosurgery (Stereotact Funct Neurosurg) Vol. 92 Issue 3 Pg. 170-7 ( 2014) ISSN: 1423-0372 [Electronic] Switzerland
• PMID: 24943284 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Aged, 80 and over
• Basilar Artery (pathology, surgery)
• Decompression, Surgical (methods, trends)
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Prospective Studies
• Radiosurgery (methods, trends)
• Treatment Outcome
• Trigeminal Neuralgia (diagnosis, etiology, surgery)