Radiosurgery for trigeminal neuralgia: is sensory disturbance required for pain relief?

Abstract:

OBJECT:Over the past 15 years stereotactic radiosurgery has become an accepted surgical option for patients with medically unresponsive trigeminal neuralgia (TN). The mechanism whereby radiosurgery causes pain relief remains unclear. METHODS:A review of recent papers on the radiosurgical management of TN reveals a correlation between maximum prescription dose and facial pain outcomes (p = 0.03) and between maximum prescription dose and new-onset trigeminal dysfunction (p < 0.01). In five of six studies in which investigators specifically analyzed whether there is any relationship between postradiosurgical trigeminal dysfunction and facial pain outcomes, there was a statistically significant greater chance of patients being pain free without medications if new trigeminal dysfunction developed after radiosurgery. Likewise, combining the results of two small series on repeated radiosurgery for TN also showed a significant correlation between postradiosurgical trigeminal dysfunction and facial pain outcomes (p = 0.02). CONCLUSIONS:Although the quality of data available does not permit a formal metaanalysis of radiosurgery for TN, the preponderance of information supports an association between the development of facial sensory loss and pain relief after radiosurgery. Consequently, radiosurgery should be considered a destructive technique in which the goal is similar to that in other percutaneous ablative techniques used to manage TN: create sufficient damage to the trigeminal system to achieve pain relief, but not so much injury that the patient is at risk for deafferentation pain syndromes.

journal_name

J Neurosurg

journal_title

Journal of neurosurgery

authors

Pollock BE

doi

10.3171/sup.2006.105.7.103

subject

Has Abstract

pub_date

2006-12-01 00:00:00

pages

103-6

eissn

0022-3085

issn

1933-0693

journal_volume

105 Suppl

pub_type

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