{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T10:26:21Z","timestamp":1785320781225,"version":"3.55.0"},"reference-count":36,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2012,1]]},"abstract":"\nObject<\/jats:title>\nVertebrobasilar ectasia (VBE) is an unusual cause of trigeminal neuralgia (TN). The surgical options for patients with medically refractory pain include percutaneous or microsurgical rhizotomy and microvascular decompression (MVD). All such procedures can be technically challenging. This report evaluates the response to a minimally invasive procedure, Gamma Knife surgery (GKS), in patients with TN associated with severe vascular compression caused by VBE.<\/jats:p><\/jats:sec>\n\nMethods<\/jats:title>\nTwenty patients underwent GKS for medically refractory TN associated with VBE. The median patient age was 74 years (range 48\u201395 years). Prior surgical procedures had failed in 11 patients (55%). In 9 patients (45%), GKS was the first procedure they had undergone. The median target dose for GKS was 80 Gy (range 75\u201385 Gy). The median follow-up was 29 months (range 8\u2013123 months) after GKS. The treatment outcomes were compared with 80 case-matched controls who underwent GKS for TN not associated with VBE.<\/jats:p><\/jats:sec>\n\nResults<\/jats:title>\nIntraoperative MR imaging or CT scanning revealed VBE that deformed the brainstem in 50% of patients. The trigeminal nerve was displaced in cephalad or lateral planes in 60%. In 4 patients (20%), the authors could identify only the distal cisternal component of the trigeminal nerve as it entered into the Meckel cave.<\/jats:p>\nAfter GKS, 15 patients (75%) achieved initial pain relief that was adequate or better, with or without medication (Barrow Neurological Institute [BNI] pain scale, Grades I\u2013IIIb). The median time until pain relief was 5 weeks (range 1 day\u20136 months). Twelve patients (60%) with initial pain relief reported recurrent pain between 3 and 43 months after GKS (median 12 months). Pain relief was maintained in 53% at 1 year, 38% at 2 years, and 10% at 5 years. Some degree of facial sensory dysfunction occurred in 10% of patients. Eventually, 14 (70%) of the 20 patients underwent an additional surgical procedure including repeat GKS, percutaneous procedure, or MVD at a median of 14 months (range 5\u201350 months) after the initial GKS. At the last follow-up, 15 patients (75%) had satisfactory pain control (BNI Grades I\u2013IIIb), but 5 patients (25%) continued to have unsatisfactory pain control (BNI Grade IV or V). Compared with patients without VBE, patients with VBE were much less likely to have initial (p = 0.025) or lasting (p = 0.006) pain relief.<\/jats:p><\/jats:sec>\n\nConclusions<\/jats:title>\nPain control rates of GKS in patients with TN associated with VBE were inferior to those of patients without VBE. Multimodality surgical or medical management strategies were required in most patients with VBE.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2011.8.jns11920","type":"journal-article","created":{"date-parts":[[2011,9,30]],"date-time":"2011-09-30T17:13:37Z","timestamp":1317402817000},"page":"73-81","source":"Crossref","is-referenced-by-count":36,"title":["Outcomes of Gamma Knife surgery for trigeminal neuralgia secondary to vertebrobasilar ectasia"],"prefix":"10.3171","volume":"116","author":[{"given":"Kyung-Jae","family":"Park","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Department of Neurosurgery, College of Medicine, Korea University, Seoul, Korea; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Kondziolka","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideyuki","family":"Kano","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oren","family":"Berkowitz","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Safee Faraz","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaomin","family":"Liu","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Gamma Knife Center, Department of Neurosurgery, 2nd Hospital of Tianjin Medical Center, Tianjin, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajay","family":"Niranjan","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Flickinger","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Radiation Oncology, University of Pittsburgh, Center for Image-Guided Neurosurgery, Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. Dade","family":"Lunsford","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns11920","series-title":"J Neurosurg","first-page":"818","article-title":"Long-term outcome after operation for trigeminal neuralgia in patients with posterior fossa tumors","volume":"84","author":"Barker","year":"1996"},{"key":"b2-jns11920","series-title":"N Engl J Med","first-page":"1077","article-title":"The long-term outcome of microvascular decompression for trigeminal neuralgia","volume":"334","author":"Barker","year":"1996"},{"key":"b3-jns11920","series-title":"BMJ","first-page":"201","article-title":"Trigeminal neuralgia and its management","volume":"334","author":"Bennetto","year":"2007"},{"key":"b4-jns11920","series-title":"Arch Neurol","first-page":"379","article-title":"Trigeminal neuralgia and multiple sclerosis","volume":"44","author":"Brisman","year":"1987"},{"key":"b5-jns11920","series-title":"Clin J Pain","first-page":"4","article-title":"Pathophysiology of trigeminal neuralgia: the ignition hypothesis","volume":"18","author":"Devor","year":"2002"},{"key":"b6-jns11920","series-title":"J Neurosurg","first-page":"532","article-title":"Mechanism of trigeminal neuralgia: an ultrastructural analysis of trigeminal root specimens obtained during microvascular decompression surgery","volume":"96","author":"Devor","year":"2002"},{"key":"b7-jns11920","series-title":"J Neurosurg","first-page":"351","article-title":"Long-term outcomes of Gamma Knife radiosurgery for classic trigeminal neuralgia: implications of treatment and critical review of the literature. 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Prospective study in a series of 579 patients","volume":"144","author":"Sindou","year":"2002"},{"key":"b31-jns11920","series-title":"AJNR Am J Neuroradiol","first-page":"61","article-title":"High-resolution computed tomography of the basilar artery: 2. Vertebrobasilar dolichoectasia: clinicalpathologic correlation and review","volume":"7","author":"Smoker","year":"1986"},{"key":"b32-jns11920","series-title":"J Neurosurg","first-page":"783","article-title":"Trigeminal neuralgia caused by compression from arteries transfixing the nerve. 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