COMMENTARY

Under the Gamma Knife for Cluster Headache

Alan R. Jacobs, MD

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September 27, 2011

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This is the Medscape Neurology Minute. I'm Dr. Alan Jacobs. Researchers from the Department of Neurological Surgery at the University of Pittsburgh have published a case series evaluating the outcomes of gamma knife surgery when used for patients with intractable cluster headache.[1] Four participating centers identified 17 patients who underwent this surgery between 1996 and 2008. The median age was 47 years and the median duration of pain before surgery was 10 years. Seven patients underwent previous unsuccessful surgical procedures, including microvascular decompression, with and without glycerol rhizotomy, deep brain stimulation, trigeminal ganglion stimulation, and previous gamma knife surgery. Fourteen patients had associated autonomic symptoms. The radiosurgical target was the trigeminal nerve root and the sphenopalatine ganglion in 8 patients, only the trigeminal nerve in 8 patients, and only the sphenopalatine ganglion in 1 patient. The median maximum doses were 80 Gy. The results showed that 10 of 17 patients achieved favorable pain relief at a median follow-up of 34 months. This was defined as Barrow Neurological Institute grades 1-3b. Eight of 16 patients who had their trigeminal nerves irradiated developed facial sensory dysfunction after gamm-knife surgery. The investigators concluded that gamma knife surgery for intractable cluster headache provided lasting pain reduction in 60% of patients but was associated with a significantly greater chance of facial sensory disturbances, more so than when this is used for trigeminal neuralgia. This article was selected from Medscape Best Evidence. I'm Dr. Alan Jacobs.

Abstract

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