title: Multiple sclerosis-related trigeminal neuralgia: a prospective series of 43 patients treated with gamma knife surgery with more than one year of follow-up.
abstract: BACKGROUND
  Trigeminal neuralgia (TN) related to multiple sclerosis (MS) is more difficult to manage pharmacologically and surgically.
  
  
  OBJECTIVE
  This article aims to evaluate the safety and efficacy of Gamma Knife surgery (GKS) in this special group of patients.
  
  
  METHODS
  Between July 1992 and November 2010, 43 cases with more than 1 year of follow-up were operated with GKS for TN related to MS and prospectively evaluated in the Timone University Hospital, Marseille, France. Radiosurgery using the Gamma Knife (model B or C or Perfexion) was performed. A single 4-mm isocenter was positioned at a median distance of 8 mm (range 5.7-14.7) anterior to the emergence of the nerve. A median maximum dose of 85 Gy (range 75-90) was delivered.
  
  
  RESULTS
  The median follow-up period was 53.8 months (12-157.1). Thirty-nine patients (90.7%) were initially pain free. Their actuarial probability of remaining pain free without medication at 6 months, 1, 3, 5 and 10 years was 87.2, 71.8, 43.1, 38.3 and 20.5%, respectively, and remained stable till 12 years. The hypoesthesia actuarial rate at 6 months, 1 and 2 years was 11.5, 11.5 and 16%, and remained stable till 12 years.
  
  
  CONCLUSIONS
  GKS proved safe and effective in this special group of patients.
authors.affiliation: Functional and Stereotactic Neurosurgery Unit, INSERM U 751, Assistance Publique-Hôpitaux de Marseille, Marseille, France.
authors.forename: Constantin
authors.initials: C
authors.lastname: Tuleasca
authors.forename: Romain
authors.initials: R
authors.lastname: Carron
authors.forename: Noémie
authors.initials: N
authors.lastname: Resseguier
authors.forename: Anne
authors.initials: A
authors.lastname: Donnet
authors.forename: Philippe
authors.initials: P
authors.lastname: Roussel
authors.forename: Jean
authors.initials: J
authors.lastname: Gaudart
authors.forename: Marc
authors.initials: M
authors.lastname: Levivier
authors.forename: Jean
authors.initials: J
authors.lastname: Régis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020220:Facial Nerve Injuries / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006987:Hypesthesia / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016634:Radiosurgery / Q000379:methods / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000209:etiology / Q000601:surgery*