Predictors of Treatment Failure following Stereotactic Radiosurgery for Trigeminal Neuralgia

Introduction: Trigeminal neuralgia (TGN) is a debilitating disease with numerous potential treatments. Many patients undergo stereotactic radiosurgery (SRS) as either initial or salvage therapy. There is little known about which patients may poorly respond to SRS as initial therapy and which of those failures may respond to more invasive modalities.

Objective: To identify which patients are most likely to fail SRS for treatment of TGN.

Method: This was a single-center, retrospective review of all adult patients with TGN who underwent SRS as their initial treatment. We collected patient demographics, symptom and treatment details, and Barrow Neurological Institute (BNI) pain outcomes data. We performed Chi-square and independent student’s t-test for categorical and continuous variables, respectively. Univariate regression analysis was performed to determine odds ratios (OR). Multivariable regression analysis was performed for variables with p < 0.10 or large effect sizes (OR ≥ 2.0 or ≤ 0.50) by univariable analysis.

Results: A total of 112 patients met inclusion criteria. Thirty (26.8%) patients required additional treatment after initial SRS, including microvascular decompression (20, 66.7%), nerve ablation/rhizolysis (6, 20%), and redo SRS (4, 13.3%). Body mass index (BMI) (p < 0.01), BNI pain score (OR: 2.29; 95% confidence interval [CI]: 0.26–19.85), trigeminal pain distribution (p = 0.10), SRS modality (p = 0.07), and initial response to SRS (p = 0.06) were included in the multivariable model. BMI (OR: 0.91 [95% CI: 0.83–0.99]) and initial response to SRS (OR: 0.29 [95% CI: 0.08–0.99]) were significant by multivariable regression analysis.

Conclusion: Predicting patients’ response to SRS remains challenging. Increasing BMI and any initial symptomatic response to SRS may suggest a reduced risk of needing further treatment. Initial BNI pain scores, Burchiel pain classifications, TGN symptomatic duration, and the presence of any imaging abnormality did not predict symptomatic response to SRS. It is imperative to counsel patients on the heterogeneous and unpredictable response to SRS and to emphasize the need for further interventions for their TGN.

Publikationsverlauf

Artikel online veröffentlicht:
05. Februar 2024