Seminars in Neurosurgery 2004; 15(2/03): 135-141
DOI: 10.1055/s-2004-835703
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Trigeminal Neuralgia Radiosurgery

Douglas Kondziolka1 , 2 , 3 , L. Dade Lunsford1 , 2 , 3 , John C. Flickinger1 , 2 , 3
  • 1Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 2Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 3the Center for Image-Guided Neurosurgery, Pittsburgh, Pennsylvania
Further Information

Publication History

Publication Date:
25 October 2004 (online)

Although medical therapy is of benefit to many patients with trigeminal neuralgia, surgical management is often performed for patients with medically refractory pain. Gamma knife radiosurgery has been advocated as a minimally invasive alternative surgical approach to microvascular decompression or percutaneous surgeries. In this article, we review the safety and efficacy of this technique and discuss potential ways to improve on results.

REFERENCES

  • 1 Leksell L. Stereotaxic radiosurgery in trigeminal neuralgia.  Acta Chir Scand. 1971;  137 311-314
  • 2 Kondziolka D, Lunsford L, Flickinger J C et al.. Stereotactic radiosurgery for trigeminal neuralgia. A multiinstitutional study using gamma knife unit.  J Neurosurg. 1996;  84 940-945
  • 3 Kondziolka D, Lunsford L, Flickinger J C. Gamma knife radiosurgery as the first surgery for trigeminal neuralgia.  Stereotact Funct Neurosurg. 1998;  70(suppl 1) 187-191
  • 4 Kondziolka D, Perez B, Flickinger J C et al.. Gamma knife radiosurgery for trigeminal neuralgia-results and expectations.  Arch Neurol. 1998;  55 1524-1529
  • 5 Lindquist C, Kihlstrom L, Hellstrand E. Functional neurosurgery-a future for the gamma knife?.  Stereotact Funct Neurosurg. 1991;  57 72-81
  • 6 Rand W, Jacques D B, Melbyer W et al.. Leksell gamma knife treatment of tic douloureux.  Stereotact Funct Neurosurg. 1993;  61 93-102
  • 7 Regis J, Metellus P, Lazorthes Y et al.. Effect of gamma knife on secondary trigeminal neuralgia.  Stereotact Funct Neurosurg. 1998;  70(suppl 1) 210-217
  • 8 Urgosik D, Vymazal J, Vladyka V et al.. Gamma knife treatment of trigeminal neuralgia: clinical and electrophysiological study.  Stereotact Funct Neurosurg. 1998;  70(suppl 1) 200-209
  • 9 Young R F, Vermeulen S S, Grimm P et al.. Gamma knife radiosurgery for treatment of trigeminal neuralgia: idiopathic and tumor related.  Neurology. 1997;  48 608-614
  • 10 Maesawa S, Salame C, Pirris S, Flickinger J C, Kondziolka D, Lunsford L D. Clinical outcomes after stereotactic radiosurgery for idiopathic trigeminal neuralgia.  J Neurosurg. 2001;  94 14-20
  • 11 Kaplan E S, Meier P. Nonparametric estimation from incomplete observation.  J Am Stat Assoc. 1958;  53 457-480
  • 12 Barker F G, Jannetta P J, Bissonette D J et al.. The long-term outcome of microvascular decompression for trigeminal neuralgia.  N Engl J Med. 1996;  334 1077-1083
  • 13 Lovely T J, Jannetta P J. Microvascular decompression for trigeminal neuralgia: surgical technique and long-term results.  Neurosurg Clin N Am. 1997;  8 11-29
  • 14 Sweet W H, Wepsic J G. Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers.  J Neurosurg. 1974;  40 143-156
  • 15 Broggi G, Flanzini A. Long-term results of percutaneous retrogasserian thermorhizotomy for “essential” trigeminal neuralgia: considerations in 1000 consecutive patients.  Neurosurgery. 1990;  26 783-787
  • 16 Scrivani J S, Keith D A, Mathews E S. Percutaneous stereotactic differential radiofrequency thermal rhizotomy for the treatment of trigeminal neuralgia.  J Oral Maxillofac Surg. 1999;  57 104-111
  • 17 Hakanson S. Trigeminal neuralgia treated by injection of glycerol into trigeminal cistern.  Neurosurgery. 1981;  9 638-646
  • 18 Jho H D, Lunsford L D. Percutaneous retrogasserian glycerol rhizotomy. Current techniques and results.  Neurosurg Clin N Am. 1997;  8 63-74
  • 19 Fraioli B, Esposito V, Guidetti B et al.. Treatment of trigeminal neuralgia by thermocoagulation, glycerolization, and percutaneous compression of the gasserian ganglion and/or retrogasserian rootlets: long-term results and therapeutic protocol.  Neurosurgery. 1989;  24 239-245
  • 20 Fujimaki T, Fukushima T, Miyazaki S. Percutaneous retrogasserian glycerol injection in the management of trigeminal neuralgia. Long-term follow-up results.  J Neurosurg. 1990;  73 212-216
  • 21 Brown J A, McDaniel M D, Weaver M T. Percutaneous trigeminal nerve compression for treatment of trigeminal neuralgia: results in 50 patients.  Neurosurgery. 1993;  32 570-573
  • 22 Hasegawa T, Spiro R, Flickinger J C, Kondziolka D, Lunsford L D. Repeat radiosurgery for trigeminal neuralgia.  Neurosurgery. 2002;  50 494-502
  • 23 Kondziolka D, Lacomis D, Niranjan A et al.. Histologic effects of trigeminal nerve radiosurgery in a primate model: implications for trigeminal neuralgia radiosurgery.  Neurosurgery. 2000;  46 971-977
  • 24 Kondziolka D, Lunsford L D, Flickinger J C. The radiobiology of radiosurgery.  Neurosurg Clin N Am. 1999;  10 157-166
  • 25 Flickinger J C, Pollock B E, Kondziolka D et al.. Does increased nerve length within the treatment volume improve trigeminal neuralgia radiosurgery? A prospective, blinded, randomized study.  Int J Radiat Oncol Biol Phys. 2001;  51 449-454
  • 26 Regis J, Bartolomei F, Metellus P et al.. Radiosurgery for trigeminal neuralgia and epilepsy.  Neurosurg Clin N Am. 1999;  10 359-377
  • 27 Pollock B E, Phuong L K, Foote R et al.. High-dose trigeminal neuralgia radiosurgery associated with increased risk of trigeminal nerve dysfunction.  Neurosurgery. 2001;  49 58-64
  • 28 Pollock B E, Phuong L K, Gorman D et al.. Stereotactic radiosurgery for idiopathic trigeminal neuralgia.  J Neurosurg. 2002;  97 347-353

Douglas KondziolkaM.D. 

Ste. B-400, UPMC Presbyterian

200 Lothrop St., Pittsburgh, PA 15213

Email: kondziolkads@msx.upmc.edu

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