Gamma Knife Radiosurgery in the Treatment of Tumor-Related Facial Pain

Authors:
  • MCMichael D. Chan
    Michael D. Chan
  • RFR. Michael Furr
    R. Michael Furr
  • DLDorothy A. Lowell
    Dorothy A. Lowell
  • TEThomas L. Ellis
    Thomas L. Ellis
  • JBJ. Daniel Bourland
    J. Daniel Bourland
  • ADAllan F. Deguzman
    Allan F. Deguzman
  • MMMichael T. Munley
    Michael T. Munley
  • KEKenneth E. Ekstrand
    Kenneth E. Ekstrand
  • ESEdward G. Shaw
    Edward G. Shaw
  • KMKevin P. McMullen
    Kevin P. McMullen
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Abstract
Background: Intracranial neoplasms can cause pain similar to trigeminal neuralgia. Literature regarding radiosurgery for this is limited. We present a retrospective review of patients with tumor-related facial pain from benign lesions treated with gamma knife radiosurgery (GKRS) at Wake Forest University. Objectives: The primary objectives were to determine long-term pain relief and predictive factors for pain alleviation. Methods: We reviewed 515 patients treated with GKRS for benign meningioma, vestibular schwannoma or trigeminal schwannoma between August 1999 and August 2010. Twenty-one eligible patients had tumor-related facial pain prior to GKRS. The median marginal tumor dose was 12 Gy. Long-term pain relief data were obtained by chart review and telephone interview. Results: The median follow-up for symptom evaluation was 3.8 years. Seventeen of 21 patients (81%) experienced a Barrow Neurological Institute (BNI) score of I–III at 6 months following GKRS. Kaplan-Meier estimates of freedom from BNI IV–V relapse were 66% at 1 year and 53% at 2 years. No pain relapses occurred after 2 years. Conclusion: GKRS of benign lesions is a noninvasive option for patients with tumor-related facial pain. Pain relief is modest, with the majority of pain relapses occurring within 2 years and approximately one half of patients maintaining relief beyond 2 years.