Trigeminal neuralgia related to megadolichobasilar artery compression: a prospective series of twenty-nine patients treated with gamma knife surgery, with more than one year of follow-up.

Constantin Tuleasca (1) , Romain Carron (1) , Noémie Resseguier (2) , Anne Donnet (3, 4) , P Roussel (5) , Jean Gaudart (2, 5) , Marc Levivier (5) , Jean Regis (6, 1)

1 Service de neurochirurgie fontionnelle et stéréotaxique
2 SESSTIM - U912 INSERM - Aix Marseille Univ - IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale
3 Centre d’évaluation et de traitement de la douleur [Hôpital de la Timone - APHM]
4 Neuro-Dol - Neuro-Dol
5 AMU - Aix Marseille Université
6 Epilepsies, Lesions Cerebrales et Systemes Neuraux de la Cognition

BACKGROUND: Trigeminal neuralgia (TN) secondary to megadolichobasilar artery (MBA) compression is considerably difficult to manage surgically. OBJECTIVE: This study aims to evaluate the safety/efficacy of Gamma Knife surgery (GKS) in this special group of patients. METHODS: Between July 1992 and November 2010, 29 patients with >1 year of follow-up presenting with MBA compression were treated with GKS at Timone University Hospital. Radiosurgery was performed using a Gamma Knife (model B, C or Perfexion). A single 4-mm isocenter was positioned in the cisternal portion of the trigeminal nerve at a median distance of 9.1 mm (range: 6-18.2 mm) from the emergence. RESULTS: The median follow-up period was 46.1 months (range: 12.9-157.9 months). Initially, all patients (100%) were pain free; the average time to complete pain relief was 13.5 days (range: 0-240 days). Their actuarial probability of remaining pain free without medication at 0.5, 1 and 2 years was 93.1, 79.3 and 75.7%, respectively, and remained stable until 13 years after treatment. The actuarial probability of hypoesthesia onset at 6 months was 4.3%; at 1 year it reached 13% and remained stable until 13 years after treatment. CONCLUSIONS: GKS proved to be reasonably safe and effective on a long-term basis as a first- and/or second-line surgical treatment for TN due to MBA compression.

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Constantin Tuleasca, Romain Carron, Noémie Resseguier, Anne Donnet, P Roussel, et al.. Trigeminal neuralgia related to megadolichobasilar artery compression: a prospective series of twenty-nine patients treated with gamma knife surgery, with more than one year of follow-up.. Stereotactic and Functional Neurosurgery, 2014, ⟨10.1159/000362172⟩. ⟨hal-01307484⟩