Gamma knife radiosurgery for trigeminal neuralgia 2002-2010

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

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     This study evaluated the effectiveness of pain relief in patients treated with gamma knife surgery (GKS) for trigeminal neuralgia (TN).
     To determine if outcomes changed during our experience.
     Seventy eight patients with typical clinical symptoms of TN were treated with GKS.
     All patients received 50-90 Gy using a single 4 mm shot. Pain relief was classified as excellent (no pain, off medication), good (no pain with medication), fair (tolerable pain with medication), poor (severe pain despite medication).
     At the last follow-up (range 3-90 months) pain control was classified as excellent in 29%, (22) good in 25% (19), fair in 9% (7), and poor in 36% (29) of the patients. Of the whole group, 27% (21) described some numbness but it was only symptomatic in 9% (7). Predictors of favorable outcome included: long history of the disease, one versus multiple branches involved, and age older than 70. None of these characteristics, however, achieved statistical significance. Women had a statistically significant better outcome than men (p < .004). Dose escalation beyond 85 Gy was not associated with improved outcome and resulted in higher incidence of sensory dysfunction. Of those patients who initially responded but relapsed, 21 (28%) were retreated and achieved a better response rate than those treated only once but with a higher incidence of numbness.
     This was a retrospective study.
     Stereotactic GKS is an effective treatment in patients with TN. It is suggested that 85 Gy represents the dose that is associated with best pain control and the least toxicity. 
     Patients who respond initially but have a recurrence of pain may be retreated with favorable results but with more toxicity.


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