Diagnosis and Management of Head and Face Pain by James Y. Suen & Erika Petersen

Author:James Y. Suen & Erika Petersen
Language: eng
Format: epub
ISBN: 9783319909998
Publisher: Springer International Publishing

Gamma Knife Radiosurgery in Multiple Sclerosis-Related Trigeminal Neuralgia

The University of Pittsburgh [21] reported on 37 patients with multiple sclerosis-related trigeminal neuralgia with a median follow-up time of 56.7 months. A single 4-mm isocenter targeting 2–8 mm anterior to the junction of the trigeminal nerve and pons was used. Median prescribed dose was 80 Gy. The median time to achieve complete pain relief (BNI score I) and reasonable pain control (BNI score I–IIIb) were 10 days and 7 days, respectively. Eventual complete pain relief and reasonable pain relief were noted in 62.1% and 97.3% of patients. One patient had no improvement. Reasonable pain control was maintained in 82.6%, 73.9%, and 54% of patients after 1, 3, and 5 years. Recurrent pain occurred in 37.8% of patients. Two patients described new unilateral facial sensory dysfunction after radiosurgery.

The Marseille [22] group reported on 43 patients with multiple sclerosis-associated trigeminal neuralgia that were treated with Gamma Knife radiosurgery. Median follow-up was 53.8 months. A single 4-mm collimator was used and positioned in the cisternal portion of the trigeminal nerve at a median distance of 8 mm anterior to the entrance of the trigeminal nerve into the brainstem. Median prescribed dose was 85 Gy. Pain was scored using three different scales: BNI (see Table 17.2), Burchiel (see Table 17.4), and Regis (see Table 17.5). For hypoesthesia evaluation, the BNI facial hypoesthesia classification was used. Thirty-nine patients (90.7%) had initial pain cessation in a median time of 30 days. Their actuarial probability of remaining pain free without medication at 6 months and 1, 3, 5, and 10 years was 87.2, 71.8, 43.1, 38.3, and 20.5%, respectively, and remained stable until 12 years. The hypoesthesia actuarial rate at 6 months, 1 year, and 2 years was 11.5, 11.5, and 16% and remained stable until 12 years.Table 17.4Burchiel classification of facial pain [23]

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