TN-RS: a novel scoring system predicts Gamma Knife Radiosurgery outcome for trigeminal neuralgia patients.

Publication Title

Acta neurochirurgica

Authors

Alon Orlev, Swedish Neuroscience Institute, Seattle, WA, USA. dr.aorlev@gmail.comFollow
James Feghali
Gil Kimchi
Lian Sun
Clifford A Pierre, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USAFollow
Cristian Gragnaniello, Swedish Neuroscience Institute, Seattle, WA, USAFollow
Cristian Cotrutz, Swedish Radiosurgery Center, Seattle, WA, USA.Follow
Christopher Loiselle, Swedish Radiosurgery Center, Seattle, WA, USA.Follow
Sandra Vermeulen, Swedish Radiosurgery Center, Seattle, WA, USA.Follow
Zachary Litvack, Swedish Neuroscience Institute, Seattle, WA, USA.Follow

Document Type

Article

Publication Date

12-1-2023

Keywords

Humans; Trigeminal Neuralgia; Retrospective Studies; Radiosurgery; Treatment Outcome; Pain; Follow-Up Studies; Radiosurgery; Risk factors; Trigeminal neuralgia; washington; swedish; swedish neurosci

Abstract

BACKGROUND: Gamma Knife Radiosurgery (GKRS) is an effective treatment option for medically refractory trigeminal neuralgia (TN). This study examines GKRS outcome in a large cohort of TN patients and highlights pretreatment factors associated with pain relief.

METHODS: This is a single-center retrospective analysis of patients treated with GKRS for TN between 2011 and 2019. Pain relief was assessed at 1 year, and 2-3 years following GKRS. Multivariable analysis identified several factors that predicted pain relief. These predicting factors were applied to establish a pain relief scoring system.

RESULTS: A total of 162 patients met inclusion criteria. At 1 year post-GKRS, the breakdown of Barrow Neurological Institute (BNI) score for pain relief was as follows: 77 (48%) score of I, 13 (8%) score of II, 37 (23%) score of III, 22 (14%) score of IV, and 13 (8%) score of V. Factors that were significantly associated with pain-free outcome at 1 year were: Typical form of TN (OR = 2.2 [1.1, 4.9], p = 0.049), No previous microvascular decompression (OR = 4.4 [1.6, 12.5], p = 0.005), Response to medical therapy (OR = 2.7 [1.1, 6.1], p = 0.018), and Seniority > 60 years (OR = 2.8 [1.4, 5.5], p = 0.003). The term "Trigeminal Neuralgia-RadioSurgery" was used to create the TN-RS acronym representing the significant factors. A stepwise increase in the median predicted probability of pain-free outcome at 1 year from 3% for patients with a score of 0 to 69% for patients with a maximum score of 4.

CONCLUSION: The TN-RS scoring system can assist clinicians in identifying patients that may benefit from GNRS for TN by predicting 1-year pain-free outcomes.

Area of Special Interest

Neurosciences (Brain & Spine)

Specialty/Research Institute

Neurosciences

DOI

10.1007/s00701-023-05835-9