SAN FRANCISCO — For people who are too old or ill to withstand the rigors of microvascular decompression, the gamma knife is a “reasonable treatment option” for recalcitrant trigeminal neuralgia, Jason Sheehan, M.D., said at the annual meeting of the Congress of Neurological Surgeons.
Microvascular decompression is the procedure with the best track record for relieving pain due to trigeminal neuralgia (TN). However, the surgery risks rare but serious complications, including brain stem infarction, cerebellar edema and hematoma, and hydrocephalus. Further, recovery often requires a stay in intensive care.
Of 136 patients, median age 68 years, who underwent radiosurgery with the gamma knife at the University of Virginia, Charlottesville, 70% reported a significant diminution of pain up to 3 years later, said Dr. Sheehan of the university. Patients included 122 with typical trigeminal neuralgia, 3 whose TN took an atypical form, 4 with facial pain associated with multiple sclerosis, and 7 whose TN was associated with a cavernous sinus tumor. A median 72 months elapsed from diagnosis to the gamma knife procedure.
One year after surgery, 90% of the patients reported significant pain relief, and 47% had no pain. At 2 years, those numbers had dropped to 77% and 45%, respectively, and at 3 years, to 70% and 34%, respectively. These findings are comparable with those of studies by different investigators, who reported pain-free outcomes of 40%-50% and an overall 70% incidence of pain relief within the first few years after surgery, Dr. Sheehan said.