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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. (C) 2014 S. Karger AG, Basel
Grégoire Courtine, Jocelyne Bloch, Léonie Asboth, Robin Jonathan Demesmaeker, Nicolas Hankov, Jimmy James Ravier, Viviana Aureli, Molywan Vat
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Andrea Serino, Robert Leeb, Oliver Alan Kannape, Skander Mensi, Sylvain Cardin, Fabien Bourban, Alexis Dorier