title: Decreased Probability of Initial Pain Cessation in Classic Trigeminal Neuralgia Treated With Gamma Knife Surgery in Case of Previous Microvascular Decompression: A Prospective Series of 45 Patients With >1 Year of Follow-up.
abstract: BACKGROUND
  Microvascular decompression (MVD) is the reference technique for pharmacoresistant trigeminal neuralgia (TN).
  
  
  OBJECTIVE
  To establish whether the safety and efficacy of Gamma Knife surgery for recurrent TN are influenced by prior MVD.
  
  
  METHODS
  Between July 1992 and November 2010, 54 of 737 patients (45 of 497 with >1 year of follow-up) had a history of MVD (approximately half also with previous ablative procedure) and were operated on with Gamma Knife surgery for TN in the Timone University Hospital. A single 4-mm isocenter was positioned in the cisternal portion of the trigeminal nerve at a median distance of 7.6 mm (range, 3.9-11.9 mm) anterior to the emergence of the nerve. A median maximum dose of 85 Gy (range, 70-90 Gy) was delivered.
  
  
  RESULTS
  The median follow-up time was 39.5 months (range, 14.1-144.6 months). Thirty-five patients (77.8%) were initially pain free in a median time of 14 days (range, 0-180 days), much lower compared with our global population of classic TN (P = .01). Their actuarial probabilities of remaining pain-free without medication at 3, 5, 7, and 10 years were 66.5%, 59.1%, 59.1%, and 44.3%. The hypoesthesia actuarial rate at 1 year was 9.1% and remained stable until 12 years (median, 8 months).
  
  
  CONCLUSIONS
  Patients with previous MVD showed a significantly lower probability of initial pain cessation compared with our global population with classic TN (P = .01). The toxicity was low (only 9.1% hypoesthesia); furthermore, no patient reported bothersome hypoesthesia. However, the probability of maintaining pain relief without medication was 44.3% at 10 years, similar to our global series of classic TN (P = .85).
authors: *Functional and Stereotactic Neurosurgery Unit, Centre Hospitalier Universitaire La Timone, Assistance Publique-Hopitaux de Marseille, Université de la Méditerranée, INSERM U 751, Marseille, France; ‡Signal Processing Laboratory (LTS 5), Swiss Federal Institute of Technology, Lausanne, Switzerland; §Medical Image Analysis Laboratory, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; ¶Centre Hospitalier Universitaire Vaudois, Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne, Switzerland; ‖University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland; #Department of Public Health and Medical Information, Centre Hospitalier Universitaire La Timone Assistance Publique-Hopitaux de Marseille, UMR 912 (INSERM-IRD-Université de la Méditerranée), Marseille, France; **Department of Neurology, Clinical Neuroscience Federation, Centre Hospitalier Universitaire La Timone Assistance Publique-Hopitaux de Marseille, Marseille, France.
authors: Constantin
authors: C
authors: Tuleasca
authors: Romain
authors: R
authors: Carron
authors: Noémie
authors: N
authors: Resseguier
authors: Anne
authors: A
authors: Donnet
authors: Philippe
authors: P
authors: Roussel
authors: Jean
authors: J
authors: Gaudart
authors: Marc
authors: M
authors: Levivier
authors: Jean
authors: J
authors: Régis
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D061145:Microvascular Decompression Surgery; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology* / Q000601:surgery; D011446:Prospective Studies; D016634:Radiosurgery; D012008:Recurrence; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000150:complications / Q000601:surgery*