Results of bilateral trigeminal neuralgia treated with gamma knife radiosurgery: Boston Gamma Knife Center experience

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

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     Bilateral trigeminal neuralgia (TN) is a rare disease with a reported incidence of 1-6 %. Gamma Knife Radiosurgery (GKRS) has been studied and shown to be effective in the treatment of unilateral TN; however, outcomes and treatment toxicities of bilateral TN treated by GKRS has not been well evaluated. 
     The purpose of this investigation is to examine and compare the outcomes and toxicities of treatment between bilateral TN and unilateral TN treated with GKRS at the Boston Gamma Knife Center.
     Data available on 7 patients were collected from medical records as well as a follow-up phone survey; one patient was lost to follow-up.
     Between 2000 and 2006, 8 patients with bilateral TN were treated with bilateral Gamma Knife Radiosurgery at Tufts Medical Center. Facial pain outcomes were defined using the modified Marseille scale. Data on toxicity (facial numbness, paresthesia, dysethesia, bad taste/loss of taste, bite weakness) was also collected and defined as none, mild or bothersome. Outcomes and toxicities were compared to our published outcomes of unilateral TN patients (n=53) treated with GKRS between 1999-2002 at Tufts Medical Center.
     The incidence of bilateral TN in our series is 2.2%. Outcomes were excellent in 36%, good in 7%, and poor in 57% of bilateral TN patients. Median follow-up time was 58 months. Median time-to-failure was 38 months. Toxicity was seen in 43% of the patients treated. Compared with our long-term unilateral TN cohort, there was no statistically significant difference in outcome or time-to-failure; there was also no statistically significant difference in the rate of toxicity.
     This was a small retrospective series.
     Effective treatment for bilateral TN is crucial to improving the quality of life for these patients. 
     This study shows that GKRS is a reasonable treatment modality for individuals with bilateral TN.


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