Two-session tumor and retrogasserian trigeminal nerve-targeted gamma knife radiosurgery for secondary trigeminal neuralgia associated with benign tumors.

Two-session tumor and retrogasserian trigeminal nerve-targeted gamma knife radiosurgery for secondary trigeminal neuralgia associated with benign tumors.

World Neurosurg. 2016 Aug 27;

Authors: Park SC, Lee DH, Lee JK

Abstract
OBJECTIVE: To investigate gamma knife radiosurgery (GKS) for benign tumor-associated secondary trigeminal neuralgia.
METHODS: From 2006 to 2015, 21 patients with secondary trigeminal neuralgia from meningioma were treated using GKS. Their mean age was 56.5 ± 12.2 years. The 50% isodose was 12.5±1.1 Gy for the first GKS for the meningioma. Retrogasserian targeting of the trigeminal nerve at 90 Gy with a 4-mm collimator was used for the second GKS.
RESULTS: The pain duration until GKS was 1.9± 1.9 years. The meningiomas were located in the cisternal space in 13 patients (56.5%) and involved the skull base in 8 patients (43.5%). The mean follow-up duration was 3.7±2.7 years. The pain control outcomes were Marseilles pain scale (MPS) scores of I-IV in 15 patients (71%). In six patients (29%), the pain control outcome was a score of V. For these patients, we performed a second GKS targeting the trigeminal nerve and resulting in MPS scores of I-IV. The tumor size did not increase in any patient and decreased >10% in 12 (80%) of the 15 patients who were followed for at least 1 year. Trigeminal nerve visibility may improve after tumor shrinkage. Retrogasserian trigeminal nerve targets may be used even with invisible trigeminal nerves using Meckel's cave as an anatomical marker.
CONCLUSIONS: Here we show the reproducible feasibility of a two-session GKS procedure using higher radiation doses: the first to treat the tumor, and the second to treat the trigeminal nerves using retrogasserian targeting.

PMID: 27576768 [PubMed - as supplied by publisher]

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