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New Study Questions Benefit of Trigeminal
Radiosurgery for Cluster Headache
Posted: March 2005
Journal of Neurology, Neurosurgery, and Psychiatry
Gamma knife treatment -- that is, trigeminal nerve
radiosurgery -- for refractory chronic cluster headache results in a
low rate of pain cessation and a high rate of nerve damage, French
investigators reported. They say the treatment is not appropriate
in this population.
"In 1998, Ford et al reported positive results after radiosurgical
targeting of the trigeminal nerve," Dr. A. Donnet, of Hospital la
Timone in Marseille, and colleagues wrote in the February Journal of
Neurology, Neurosurgery and Psychiatry. "Since this initial report
no other attempts have been made to evaluate trigeminal nerve
radiosurgery in chronic cluster headache and no long-term follow-up
study has been published by Fordís team," the researchers pointed out.
They therefore conducted a multicenter, prospective, self-controlled
study to examine the safety and efficacy of gamma knife treatment in
chronic cluster headache. Included in the study were 10 patients
with severe, drug-resistant cluster headache with a mean duration of
nine years. The team targeted the cisternal segment of the nerve
with a single 4-mm. collimator, and the patients were followed for a
mean of 13.2 months.
Three of the patients experienced immediate or near-immediate relief
of chronic cluster headache and had no further attacks, while three
others demonstrated marked improvement and had few attacks per month
or very few attacks in the last six months.
Two patients, on the other hand, had freedom from pain for only one
and two weeks. Thereafter, their cluster headaches recurred with
the same severity and frequency as before. No improvement was
observed in two other patients.
No complications were observed immediately after the gamma knife
treatment, but three patients developed paraesthesia with no
hypoesthesia, one developed hypoesthesia, and one developed
"Our study does not support the positive results of the study of
Ford et al", Dr. Donnetís team concluded. "The rate and severity of
trigeminal nerve injury appear to be significantly higher than in
trigeminal neuralgia", they noted. "We consider the morbidity
to be significant for a low rate of pain cessation making this
procedure less attractive even for the more severely affected
subgroup of patients."