Gamma Knife Radiosurgery for trigeminal neuralgia : The PNUH experience

Keywords: trigeminal neuralgia, gamma knife, pain, outcome, radiosurgery

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     Trigeminal neuralgia can be classified into idiopathic and secondary according to the cause. Gamma Knife surgery(GKS) could be a good treatment modality in selected cases. 
     We assessed the clinical outcomes in patients treated with gamma knife radiosurgery for trigeminal neuralgia.
     A total of 1113 patients have been treated, 26 for trigeminal neuralgia. This study includes the initial 24 trigeminal neuralgia with follow-up exceeding 6 months and composed of 17 females and 7 males.
     PNUH Gamma Knife Center has been operation since October 20, 2003.  None of the patients had multiple sclerosis and only two patients were secondary trigeminal neuralgia associated with brain tumor. The median patient age was 61 and their mean symptom duration was 81 months. Patients were treated through the routine process using a single 4-mm isocenter targeting the trigeminal nerve at its junction with the pons with or without plugs. The maximum dose range was 70 Gy to 85 Gy. Patients were followed for a minimum of 6 months and a maximum of 7 years (Median follow-up was 1.4 years).
     Six months after GKS, 16 patients reported an “excellent” response as defined by a complete relief of pain without medication or remained occasionally pain but no longer taking any medication, and 8 patients had “good” response as defined by a decreased pain in the amount of pain medication required. At time of last follow up, 14 patients had an “excellent” response, and 9 had a “good” response. One patient experienced a major recurrence of neuralgia. Mean intervals to symptoms improvement were 1.4 months and there is no severe complication after GKS.
     This was a retrospective study.
     As the least invasive option, GKS maintains facial sensation in the vast majority of patients and can be used in all patients regardless of age or medical condition. 
     GKS could be safe and effective in the treatment of medically refractory trigeminal neuralgia and is of value for initial or recurrent pain management.


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