Radiosurgery for Trigeminal Neuralgia Secondary to Dolichoectatic Vessels: Case Series and Review of Literature
Even for seasoned neurosurgeons who have mastered the microvascular decompression (MVD) techniques, trigeminal neuralgia (TGN) secondary to vertebrobasilar dolichoectatic vessels remains a challenge. Often, patient is either medically infirm or unwilling for invasive surgical interventions. Alternat...
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2021-04-01
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doaj-e980d53884f244b1848d6398e0cc89d42021-07-19T23:21:56ZengThieme Medical and Scientific Publishers Pvt. Ltd.Journal of Neurosciences in Rural Practice0976-31470976-31552021-04-01120345546010.1055/s-0041-1726150Radiosurgery for Trigeminal Neuralgia Secondary to Dolichoectatic Vessels: Case Series and Review of LiteratureManjul Tripathi0Sandeep Mohindra1Renu Madan2Chirag K. Ahuja3Aman Batish4Rupinder Kaur5Sushant Dutta6Ninad R. Patil7Vasundhara S. Rangan8Sonikpreet Aulakh9Department of Neurosurgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, IndiaDepartment of Neurosurgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, IndiaDepartment of Radiotherapy, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, IndiaDepartment of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, IndiaDepartment of Neurosurgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, IndiaDepartment of Neurosurgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, IndiaDepartment of Neurosurgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, IndiaDepartment of Neurosurgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, IndiaDepartment of Neurosurgery, Nizam Institute of Medical Sciences, Hyderabad, IndiaDepartment of Translational Neuro-Oncology, West Virginia Cancer Institute, Morgantown, United StatesEven for seasoned neurosurgeons who have mastered the microvascular decompression (MVD) techniques, trigeminal neuralgia (TGN) secondary to vertebrobasilar dolichoectatic vessels remains a challenge. Often, patient is either medically infirm or unwilling for invasive surgical interventions. Alternative treatment options including Gamma Knife radiosurgery (GKRS) are considered in such a situation with variable success. This study aimed to evaluate the role of GKRS in patients with trigeminal neuralgia with dolichoectatic vessels and severe cross compression. We prospectively managed three male patients of intractable TGN secondary to dolichoectatic vascular compression with single-session GKRS. The cisternal component of the trigeminal nerve was targeted with 90 Gy radiation at 100% isodose with a single 4-mm collimator. The patients were regularly evaluated on clinical parameters for pain relief (Barrow Neurological Institute (BNI) score), sensory complaints, and outcome. All patients had satisfactory pain control (BNI I–IIIa) at 3 months of interval only to get recurrent pain (BNI IV–V) after 6 months. The treatment was eventually considered a failure after 6-month duration and one patient needed MVD for pain control. Post-GKRS pain control remains inferior in patients with dolichoectasia compared with typical TGN. GKRS should be offered only as a salvage or rescue procedure and should not be used as an alternative treatment of MVD in patient population with dolichoectatic vessels.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1726150gamma knife radiosurgerymegadolicobasilar arterytrigeminal neuralgiamicrovascular decompression |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Manjul Tripathi Sandeep Mohindra Renu Madan Chirag K. Ahuja Aman Batish Rupinder Kaur Sushant Dutta Ninad R. Patil Vasundhara S. Rangan Sonikpreet Aulakh |
spellingShingle |
Manjul Tripathi Sandeep Mohindra Renu Madan Chirag K. Ahuja Aman Batish Rupinder Kaur Sushant Dutta Ninad R. Patil Vasundhara S. Rangan Sonikpreet Aulakh Radiosurgery for Trigeminal Neuralgia Secondary to Dolichoectatic Vessels: Case Series and Review of Literature Journal of Neurosciences in Rural Practice gamma knife radiosurgery megadolicobasilar artery trigeminal neuralgia microvascular decompression |
author_facet |
Manjul Tripathi Sandeep Mohindra Renu Madan Chirag K. Ahuja Aman Batish Rupinder Kaur Sushant Dutta Ninad R. Patil Vasundhara S. Rangan Sonikpreet Aulakh |
author_sort |
Manjul Tripathi |
title |
Radiosurgery for Trigeminal Neuralgia Secondary to Dolichoectatic Vessels: Case Series and Review of Literature |
title_short |
Radiosurgery for Trigeminal Neuralgia Secondary to Dolichoectatic Vessels: Case Series and Review of Literature |
title_full |
Radiosurgery for Trigeminal Neuralgia Secondary to Dolichoectatic Vessels: Case Series and Review of Literature |
title_fullStr |
Radiosurgery for Trigeminal Neuralgia Secondary to Dolichoectatic Vessels: Case Series and Review of Literature |
title_full_unstemmed |
Radiosurgery for Trigeminal Neuralgia Secondary to Dolichoectatic Vessels: Case Series and Review of Literature |
title_sort |
radiosurgery for trigeminal neuralgia secondary to dolichoectatic vessels: case series and review of literature |
publisher |
Thieme Medical and Scientific Publishers Pvt. Ltd. |
series |
Journal of Neurosciences in Rural Practice |
issn |
0976-3147 0976-3155 |
publishDate |
2021-04-01 |
description |
Even for seasoned neurosurgeons who have mastered the microvascular decompression (MVD) techniques, trigeminal neuralgia (TGN) secondary to vertebrobasilar dolichoectatic vessels remains a challenge. Often, patient is either medically infirm or unwilling for invasive surgical interventions. Alternative treatment options including Gamma Knife radiosurgery (GKRS) are considered in such a situation with variable success. This study aimed to evaluate the role of GKRS in patients with trigeminal neuralgia with dolichoectatic vessels and severe cross compression. We prospectively managed three male patients of intractable TGN secondary to dolichoectatic vascular compression with single-session GKRS. The cisternal component of the trigeminal nerve was targeted with 90 Gy radiation at 100% isodose with a single 4-mm collimator. The patients were regularly evaluated on clinical parameters for pain relief (Barrow Neurological Institute (BNI) score), sensory complaints, and outcome. All patients had satisfactory pain control (BNI I–IIIa) at 3 months of interval only to get recurrent pain (BNI IV–V) after 6 months. The treatment was eventually considered a failure after 6-month duration and one patient needed MVD for pain control. Post-GKRS pain control remains inferior in patients with dolichoectasia compared with typical TGN. GKRS should be offered only as a salvage or rescue procedure and should not be used as an alternative treatment of MVD in patient population with dolichoectatic vessels. |
topic |
gamma knife radiosurgery megadolicobasilar artery trigeminal neuralgia microvascular decompression |
url |
http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1726150 |
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