Long term outcomes of Gamma knife surgery for classic trigeminal neuralgia in patients younger than 50 years

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

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     Gamma knife surgery (GKS) has been used as an alternative, minimally invasive treatment in medically refractory trigeminal neuralgia (TN) although microvascular decompression (MVD) has historically been the treatment of choice for TN in young patient because of its long term pain relief. 
     We evaluated the long-term results of GKS in the treatment of TN patients younger than 50 years.
     From 2004 to 2009, 19 cases in 18 patients younger than 50 years were treated with GKS. Follow-up was obtained by surveys and review of medical records.
      The type of TN was all Classical TN. In this group, the radiosurgical target was Retrogasserian portion. The maximal radiation doses ranged from 75 to 90 Gy. The median age of the patients was 43 years (range 34-49 years), and the median time from diagnosis to GKS was 55 months (range 12-180 months). The median follow up was 67 months (range 32-93 months).
     During follow up period, all patients reported initial pain relief and the pain was controlled in 17 patients (89.5%, BNI I-III) while 11 patients (57.9%) achieved pain free state without medications (BNI I) at the last follow up. BNI score of I-III was found in all 19 cases (100%) at 2 years, 15/17 (88.2%) at 3years, 13/13 at 4 years, 11/11 at 5 years, 9/9 at 6years, 3/3 at 7years, respectively. The young patients who were under 50 years old (n=19) showed higher pain control rate than elderly patients (89.5% vs 80.6%). New onset of facial dysfunction following GKS were reported as BNI facial numbness score II in 5 patients.
     This was a retrospective series.
     GKRS is a reasonable long-term treatment option for young patients unwilling or unable to undergo more invasive surgical approaches. 
     Gamma knife radiosurgery yields durable pain control in a majority of patients, as well as improved quality of life with limited complications and it does not significantly affect the efficacy of other surgical treatments, should they be needed.


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