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        Cluster Headache Help and Support >> Medications, Treatments, Therapies >> Nerve radiosurgery evaluation (2 of 2)
        
(Message started by: Bob_Johnson on Feb 7^th, 2007, 10:22am)

Title: Nerve radiosurgery evaluation (2 of 2)
Post by Bob_Johnson on Feb 7^th, 2007, 10:22am

Neurosurgery. 2006 Dec;59(6):1258-62; discussion 1262-3.

Long-term results of radiosurgery for refractory cluster headache.

McClelland S 3rd, Tendulkar RD, Barnett GH, Neyman G, Suh JH.

Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA.

OBJECTIVE: Medically refractory cluster headache (CH) is a debilitating condition for which few surgical modalities have proven effective. Previous reports involving short-term follow-up of CH patients have reported modest degrees of pain relief after radiosurgery of the trigeminal nerve ipsilateral to symptom onset. With the recent success of deep brain stimulation as a surgical modality for these patients, it becomes imperative for the long-term risks and benefits of radiosurgery to be more extensively delineated. To address this issue, we present our findings from the largest retrospective series of patients undergoing radiosurgery for CH with extended follow-up periods. METHODS: Between 1997 and 2001, 10 patients with CH underwent gamma knife radiosurgery at our institution. All patients fulfilled clinical criteria for treatment, including complete resistance to pharmacotherapy (usually methysergide, verapamil, and lithium), pain primarily localized to the ophthalmic division of the trigeminal nerve, and psychological stability. The mean age at radiosurgery was 40.3 years (range, 26-62 yr), and the average CH duration was 11.3 years (range, 2-21 yr). Patients received 75 Gy to the 100% isodose line delivered to the most proximal part of the trigeminal nerve where the 50% isodose line was outside the brainstem (4-mm collimator), with a mean follow-up period of 39.7 months (range, 5-88 mo). Pain relief was defined as excellent (free of CH with minimal or no medications), good (50% reduction of CH severity and frequency with medications), fair (25% reduction of CH severity and frequency with medications), or poor (less than 25% reduction of CH severity and frequency with medications). RESULTS: After radiosurgery, pain relief was poor in nine patients and fair in one patient. Six patients with poor to fair relief initially experienced excellent to good relief (range, 2 wk-2 yr after treatment) before regressing. Five patients (50%) experienced trigeminal nerve dysfunction, manifesting predominantly as facial numbness after treatment. CONCLUSION: Although some patients may experience short-term pain relief, none had relief sustainable for longer than 2 years. The results from this series indicate that radiosurgery of the trigeminal nerve does not provide long-term pain relief for medically refractory CH.

PMID: 17277688

Title: these, vRe: Nerve radiosurgery evaluation (2 of 2)
Post by andrewjb on Feb 7^th, 2007, 10:13pm

:). thankyou for posting boh of these, very interesting. andrew.

Title: Re: Nerve radiosurgery evaluation (2 of 2)
Post by Gator on Feb 13^th, 2007, 12:33am

Many thanks for all the researching and posting of your findings. We are all able to make better informed choices because of people like you.

Mike

Title: Re: Nerve radiosurgery evaluation (2 of 2)
Post by cluster on Feb 19^th, 2007, 11:06am

Thanks Bob,

more news from the same authors in "Headache" Febr. 2007:

Repeat trigeminal nerve radiosurgery for refractory cluster headache fails to provide long-term pain relief.

* McClelland S 3rd,
* Barnett GH,
* Neyman G,
* Suh JH.

Objective/Background.-Medically refractory cluster headache (MRCH) is a debilitating condition that has proven resistant to many modalities. Previous reports have indicated that radiosurgery for MRCH provides little long-term pain relief, with moderate/significant morbidity. However, there have been no reports of repeated radiosurgery in this patient population. We present our findings from the first reports of repeat radiosurgery for MRCH. Methods.-Two patients with MRCH underwent repeat gamma knife radiosurgery at our institution. Each fulfilled clinical criteria for treatment, including complete resistance to pharmacotherapy, pain primarily localized to the ophthalmic division of the trigeminal nerve, and psychological stability. Both patients previously received gamma knife radiosurgery (75 Gy) for MRCH with no morbidity, but no long-term improvement of pain relief (Patient 1 = 5 months, Patient 2 = 10 months) after treatment. For repeat radiosurgery, each patient received 75 Gy to the 100% isodose line delivered to the root entry zone of the trigeminal nerve, and was evaluated postretreatment. Pain relief was defined as: excellent (free of MRCH with minimal/no medications), good (50% reduction of MRCH severity/frequency with medications), fair (25% reduction), or poor (less than 25% reduction). Results.-Following repeat radiosurgery, long-term pain relief was poor in both patients. Neither patient sustained any immediate morbidity following radiosurgery. Patient 2 experienced right facial numbness 4 months postretreatment, while Patient 1 experienced no morbidity. Conclusion.-Repeat radiosurgery of the trigeminal nerve fails to provide long-term pain relief for MRCH. Given the reported failures of initial and repeat radiosurgery for MRCH, trigeminal nerve radiosurgery should not be offered for MRCH.

(Source, PubMed) (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17300376&itool=iconabstr&query_hl=2&itool=pubmed_docsum)

Title: Re: Nerve radiosurgery evaluation (2 of 2)
Post by clusterwife on Feb 20^th, 2007, 3:16pm

My hubby Kevin had TN surgery 2.5 yrs. ago with outstanding results. It was scary for him at first, now he is adjusted and happier than I've seen him in years. Hope all is well, Leah.

Title: Re: Nerve radiosurgery evaluation (2 of 2)
Post by UN solved on Feb 20^th, 2007, 7:12pm

Thanks for posting this information Bob.

UNsolved

Title: Re: Nerve radiosurgery evaluation (2 of 2)
Post by georgej on Feb 20^th, 2007, 8:02pm

on 02/20/07 at 19:12:41, UN solved wrote:

Thanks for posting this information Bob.

UNsolved

Yes, and thank you for the additional citation, Friedrich.

Best,

George

Title: Re: Nerve radiosurgery evaluation (2 of 2)
Post by chewy on Feb 21^st, 2007, 6:40am

Clusterwife's contradictory post:

Quote:

Hi, I'm clusterwife, and as in my name, I'm married to a chronic clusterhead. He had TN surgery on his left side, worked well for a couple of years. Now he is getting hits on the right side. Surgery again is out of the question, he has to suffer for his life. He is depressed, and feeling lost. I need all the help and support from you all on the board to help him the best I can. I tried to tell him he needs to get back on the meds to "prevent" them from coming, but he is reluctant. Thanks for listening.

Which is it ?

FYI to anyone who doesn't know. Her hubby was on the boards selling surgery like RONCO sells salad shooters.

Title: Re: Nerve radiosurgery evaluation (2 of 2)
Post by georgej on Feb 21^st, 2007, 9:10am

on 02/21/07 at 06:40:05, chewy wrote:

Which is it ?

It's a good question. Surgery is an extreme (not to mention expensive) option with attendant risks. If it was actually less than successful, why the two posts in two threads that advocate it? If it was completely successful, why the original post on the supporter's board in October?

George

Title: Re: Nerve radiosurgery evaluation (2 of 2)
Post by andrewjb on Feb 21^st, 2007, 10:18pm

:). i was a little concerned when i read, "hubby kevin, is now adjusted and happy", :o. thanks for being here chewy. andrew.

Title: Re: Nerve radiosurgery evaluation (2 of 2)
Post by clusterwife on Mar 1^st, 2007, 2:56pm

Sorry, he only tells me when I ask directly. We thought the headaches on the right side were cluster, ended up being a bunch of bad teeth. In my opinion, he has a better life since surgery. He still gets hits on the numb side, and wakes up around 2:30 a.m. He uses oxygen when it's bad. The surgery isn't perfect. Neither is the pain. Neither are most of the treatments. I don't mean to seem to be selling anything, but I am willing to step on a few toes to spread the hope and knowledge that I've grown to love in exchange for bitterness. Hope all is well, Leah.

Title: Re: Nerve radiosurgery evaluation (2 of 2)
Post by nani on Mar 1^st, 2007, 8:01pm

Hi Leah. I'm glad that Kevin feels it was worth it. None of us can judge that, can we? I think it's a good thing when we share our experiences, even if not every treatment is for every sufferer. Best to you and Kevin... hugs, nani