Gamma knife radiosurgery for benign tumor-related trigeminal neuralgia: a single-institution retrospective study.

in Neurosurgical review by Binh Thanh Nguyen, Chuong Thanh Huynh, Tu Minh Nguyen, Vu Tuong Nguyen, Constantine L Karras, Huy Minh Tran

TLDR

  • The study found that GKRS targeting both tumor and trigeminal nerve in a single session achieved favorable outcomes in terms of pain relief and tumor control in patients with benign tumor-related trigeminal neuralgia

Abstract

Gamma knife stereotactic radiosurgery (GKRS) is recognized as an effective and safe alternative treatment for skull base tumors and trigeminal neuralgia. This study aims to evaluate the efficacy of targeting both tumor and trigeminal nerve in a single procedure for patients with benign tumor-related trigeminal neuralgia. A retrospective study was conducted on 44 patients with benign tumor-related trigeminal neuralgia who underwent GKRS targeting both tumor and trigeminal nerve in a single procedure between December 2016 and December 2022. The cohort included 30 meningiomas, 9 vestibular schwannomas, and 5 trigeminal schwannomas. The median tumor volume was 3.62 mL (range: 0.14-20.74 mL). The median radiation dose was 12-13.4 Gy for the tumors and 88.9 Gy (range: 85-90 Gy) at the 100% isodose line for the trigeminal nerve. The facial pain before and after GKRS was assessed using the Barrow Neurological Institute (BNI) pain intensity scale. Following GKRS, 38 patients (86.4%) experienced significant pain improvement, with a median latency period of 2 months (range: 0.3-12 months). Sixteen patients (36.4%) experienced a relapse at a median time of 6 months (range: 1-30 months) post-GKRS. After a median follow-up time of 31.9 months (12.1-77.3 months), 22 patients (50.0%) continued to experience durable pain relief. Fourteen patients (31.8%) developed GKRS-related complications, most of which fully resolved, except in 3 patients (6.8%) who experienced permanent facial hypoesthesia. Tumor control rate was 86.2%. GKRS targeting both the tumor and trigeminal nerve in a single session demonstrated favorable outcomes in terms of pain relief and tumor control in patients with benign tumor-related trigeminal neuralgia.

Overview

  • The study aimed to evaluate the efficacy of targeting both tumor and trigeminal nerve in a single procedure for patients with benign tumor-related trigeminal neuralgia using Gamma knife stereotactic radiosurgery (GKRS)
  • The study conducted a retrospective analysis of 44 patients who underwent GKRS between December 2016 and December 2022, with a median tumor volume of 3.62 mL and a median radiation dose of 12-13.4 Gy for tumors and 88.9 Gy for the trigeminal nerve
  • The study sought to determine the efficacy of GKRS in achieving pain relief and tumor control in patients with benign tumor-related trigeminal neuralgia

Comparative Analysis & Findings

  • The study found that 38 patients (86.4%) experienced significant pain improvement after GKRS, with a median latency period of 2 months and 16 patients (36.4%) experienced a relapse at a median time of 6 months
  • The study reported a tumor control rate of 86.2% and 22 patients (50.0%) continued to experience durable pain relief after a median follow-up time of 31.9 months
  • Fourteen patients (31.8%) developed GKRS-related complications, most of which fully resolved, except in 3 patients (6.8%) who experienced permanent facial hypoesthesia

Implications and Future Directions

  • The study suggests that GKRS targeting both the tumor and trigeminal nerve in a single session is a effective treatment for patients with benign tumor-related trigeminal neuralgia
  • Future studies can focus on addressing the limitations of the study, including the relatively small sample size and the need for further investigation into the long-term outcomes of GKRS in patients with benign tumor-related trigeminal neuralgia
  • Future studies can also explore alternative dosing regimens and techniques to improve treatment outcomes and minimize complications
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