Saikia Amrit Kumar*, Ranjan Manish and Pandey Paritosh

Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India

*Corresponding Author: Saikia Amrit Kumar, Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India.

Received: June 20, 2024; Published: July 30, 2024

Abstract

Introduction: Symptomatic trigeminal neuralgia sometimes occurs secondary to intracranial skull base tumor. GKRS has been reported as a potential treatment option for tumor-related trigeminal neuralgia. However, there is paucity of literature from India on the clinical outcome of GKRS for symptomatic trigeminal neuralgia.

Aims and Objectives: The primary objective of this study is to evaluate the efficacy and safety of Gamma Knife Radio Surgery with respect to relief of facial pain and tumor control in patients of tumor related

trigeminal neuralgia and to identify predictive factors of outcome.

Material and Methods: This is a retrospective study of patients with tumor related trigeminal neuralgia, evaluated and treated with Gamma Knife Radio Surgery at the National Institute of Mental Health And Neurosciences (NIMHANS), Bangalore since March 2006 to June 2013 with minimum of 6 months of follow up. Medical case records and images were reviewed. Pain intensity at the time of diagnosis/treatment and at follow up after GKRS was quantified using the Barrow Neurological Institute (BNI) criteria.

Results and Observations: Sixty-seven patients were treated for tumor with trigeminal neuralgia during the study period. 60 patients were included in the study. The most common tumor was vestibular schwannoma 27(45%), followed by meningioma 23(38.33%), trigeminal schwannoma 9(15%) and cavernous sinus hemangioma 1(1.67%). The mean follow up duration was 35.4 months (range, 7-70 moths). The mean tumor volume was 4.4 cc and mean radiation dose was 12.7 Gy. Onset of initial improvement of pain was achieved in a mean duration of 21 days. There was 46.7% BNI-I pain control, 43.3% BNI-II, 5% BNI-III and 5% BNI –IV/V. Post GKRS tumor volume reduction has significant (p < 0.05) correlation with good pain control. Higher treatment dose is correlated with good pain control.

Conclusion: Excellent pain control and tumor control with better quality of life is possible with a minimally invasive fashion using Gamma Knife Radio Surgery. Primary Gamma Knife Radio Surgery can be considered as a preferable therapeutic option in carefully selected patients with tumor related symptomatic trigeminal neuralgia.

 Keywords: BNI (Barrow Neurological Institute); Gamma Knife Radio Surgery (GKRS);

References

1. Cheng TM., et al. “Comprehensive study of diagnosis and treatment of trigeminal neuralgia secondary to tumors”. Neurology 43 (1993): 2298-2302.
2. Young RF., et al. “Gamma knife radiosurgery for treatment of trigeminal neuralgia: idiopathic and tumor related”. Neurology 48 (1997): 608-614.
3. Pollock BE., et al. “Stereotactic radiosurgery for tumor-related trigeminal pain”. Neurosurgery 46 (2000): 576-582, 582-573.
4. Huang CF., et al. “Gamma knife surgery for trigeminal pain caused by benign brain tumors”. Journal of Neurosurgery 109 (2008): 154-159.
5. Sarah E Squire., et al. “Gamma knife radiosurgery in the treatment of tumor-related facial pain”. Stereotactic and Functional Neurosurgery 90 (2012): 145-150.
6. Rogers CL., et al. “Gamma knife radiosurgery for trigeminal neuralgia: the initial experience of The Barrow Neurological Institute”. International Journal of Radiation Oncology - Biology - Physics 47 (2000): 1013-1019.
7. Chang JW., et al. “The effects of stereotactic radiosurgery on secondary facial pain”. Stereotactic and Functional Neurosurgery 72 (1999): 29-37.
8. Kano H., et al. “Stereotactic radiosurgery for patients with trigeminal neuralgia associated with petroclival meningiomas”. Stereotactic and Functional Neurosurgery 89 (2011): 17-24.
9. Kano H., et al. “Stereotactic radiosurgery for trigeminal schwannoma. Tumor control and functional preservation. Clinical article”. Journal of Neurosurgery 110 (2009): 553-558.
10. Regis J., et al. “Long-term outcome after gamma knife surgery for secondary trigeminal neuralgia”. Journal of Neurosurgery 95 (2001): 199-205.
11. Tanaka S., et al. “Stereotactic Radiosurgery for Trigeminal Pain Secondary to Benign Skull Base Tumors”. World neurosurgery3/4 (2013): 371-377.
12. Spiegelmann R., et al. “Cavernous sinus meningiomas: a large LINAC radiosurgery series”. Journal of Neurooncology 98 (2010): 195-202.
13. Hasegawa T., et al. “Trigeminal schwannomas: results of gamma knife surgery in 37 cases”. Journal of Neurosurgery 106 (2007): 18-23.
14. Nicolato A., et al. “Radiosurgical treatment of cavernous sinus meningiomas: experience with 122 treated patients”. Neurosurgery 51 (2002): 1153-1159.
15. Puca A and Meglio M. “Typical trigeminal neuralgia associated with posterior cranial fossa tumors”. Italian Journal of Neurological Sciences 14 (1993): 549-552.
16. Jamjoom A., et al. “Trigeminal neuralgia related to cerebellopontine angle tumors”. Neurosurgery Review 19 (1996): 237-241.

Citation

Citation: Saikia Amrit Kumar., et al. “Outcome of Gamma Knife Radio Surgery in the Treatment of Tumor-Related Symptomatic Trigeminal Neuralgia: Our initial experiences from National Institute of Mental Health and Neurosciences (NIMHANS)”. Acta Scientific Neurology 7.8 (2024): 31-36.

Copyright

Copyright: © 2024 Saikia Amrit Kumar., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.