| Treatment Outcome of Idiopathic Trigeminal Neuralgia |
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Hyuk Jai Choi, Young Jin Lim, Won Seob Seo, Seok Keun Choi, Jun Seok Koh, Tae Sung Kim, Bong Arm Rhee, Gook Ki Kim |
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Department of Neurosurgery, School of Medicine, Kyung Hee University, Seoul, Korea |
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| Abstract |
Objective
Microvascular Decompression (MVD) has been the treatment of choice for trigeminal neuralgia (TN). Gamma knife radiosurgery (GKRS) has been used as an alternative and non-invasive treatment for TN. The indications and treatment outcomes of MVD and GKRS are still a controversy. In the present study, we evaluated the clinical results of these two surgeries and focused on deciding the indications of GKRS and MVD.
Material and Method: From 1994 to 2005, 78 patients of TN were treated by MVD and 22 patients were treated by GKRS. In the MVD group, MVD, rhizotomy was done simultaneously while in the GKRS group the maximum dose of the radiation used was 77.1 Gy (65.2-83.6Gy) and in all cases, the 4mm collimator was used to target the radiation to the root entry zone (REZ). These patients were comparatively analyzed according to the age, the duration of symptoms, surgical results, complications and recurrence.
Result: The mean age of the GKRS group was older than the MVD group (MVD : 53.9 years old, GKRS : 61.3 years old). The mean follow up period was 30.9 months and 31 months. According to the pain intensity scale at last follow up, grade 1, 2 (pain-free with or without medication) were 56 cases (71.8%) in the MVD group and 10 cases (45.4%) in the GKRS group. 10 patients (12.8%) of MVD group and 3 patients (13.6%) of GKRS group experienced a recurrence of pain. In post-operative complications, the MVD group had permanent disability in 11 cases (14.1%) and the GKRS group had abnormal sensations in 2 cases (9.5%).
Conclusion
Although our treatment outcome of GKRS was not so good as the results of MVD, GKRS is a valuable primary
treatment modality for TN. Proper patient selection of each treatment modality is essential in surgical management of TN. |
| Key Words:
Trigeminal neuralgia, Microvascular decompression, Gamma knife radiosurgery. |
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