Brainstem and trigeminal nerve changes after radiosurgery for trigeminal pain

Alessandra Gorgulho, Antonio A F De Salles, David McArthur, Nzhde Agazaryan, Paul Medin, Timothy Solberg, Carlos Mattozo, Judith Ford, Steve Lee, Michael T. Selch

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

Purpose: To evaluate the significance of radiological changes on follow-up MRIs after SRS for TN. Materials and Methods: Thirty-seven patients with follow-up MRI because of paresthesias, bilateral treatment, or failure were analyzed regarding pain outcome and complications. Mean age was 64.4 years; 14 underwent previous treatment. Twenty-nine had ETN, 5 secondary TN due to tumor or multiple sclerosis, and 3 had atypical TN. Ninety gray was prescribed for 20 patients, 70 Gy for 5, and 80/85 Gy for 2. A 5-mm collimator was used in 32 (88.9%) cases. Mean follow-up was 15 months (range, 4-52 months). Results: Excellent/good pain relief was sustained in 67% of cases at 13 months' follow-up. Enhancement on MRIs was observed in 21 cases (56.75%) with nerve enhancement in 9, pons enhancement in 4, pons-nerve enhancement in 4, and tumor enhancement in 4. Magnetic resonance images were unremarkable in 16 cases. Pain recurred in 4 cases (5.5-10 months). Pons enhancement correlated with pain relief (P = .0087) but not with nerve enhancement (P = .22). Incidence of slight paresthesias was 66.6%. No anesthesia dolorosa or ophthalmologic problems were observed. Paresthesias correlated with enhancement (P = .02), but not with brainstem volume encompassed by the 20%, 30%, and 50% isodoseline (P = .689, .525, .908). Enhancement free probability at 12 months was 48.5% (Kaplan-Meier). Conclusions: Pons enhancement seems to be prognostic for pain relief without higher incidence of complications. Pons volume irradiated did not predict enhancement occurrence. Radiation delivery to the brainstem-REZ interface seems to improve pain outcome, although more paresthesias should be expected.

Original languageEnglish (US)
Pages (from-to)127-135
Number of pages9
JournalSurgical Neurology
Volume66
Issue number2
DOIs
StatePublished - Aug 1 2006

Keywords

  • Brainstem
  • Enhancement
  • Magnetic resonance image
  • Radiosurgery
  • Trigeminal neuralgia

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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