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New Study Questions Benefit of Trigeminal
Radiosurgery for Cluster Headache

Posted: March 2005  
Journal of Neurology, Neurosurgery, and Psychiatry
2005;76:218-221

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 Ford’s 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 deafferentation pain.

"Our study does not support the positive results of the study of Ford et al", Dr. Donnet’s 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."