Gamma Knife Surgery For Recurrent Or Residual Trigeminal Neuralgia

Chuan-Fu Huang1, Shyh-Ying Chiou2, Hsien-Tang Tu2, Jim-Chao Chuang2, Long-Yau Lin2

1Taichung , Taiwan, Province Of China 2Chung Shan Medical University Hospital, Taichung, Taiwan

Keywords: gamma knife, pain, trigeminal neuralgia, outcome, recurrent disease

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     The purpose of this study was to assess outcome of gamma knife surgery (GKS) for recurrent trigeminal neuralgia (TN), either from failed microvascular decompression (MVD), percutaneous radiofrequency (PRF) or GKS.
     From 1999 to 2007, a total of 65 patients with recurrent trigeminal neuralgia were treated with Leksell gamma knife. Of 65 patients, all had undergone medical treatment, 27 (42%) had undergone microvascular decompression (MVD), 8 (12%) had undergone percutaneous radiofrequency (PRF) and 30 (46%) had failure of Gamma Knife surgery (GKS).
     Mean follow up was 24 to 108 months (mean, 60 months). The entry zone of trigeminal nerve was targeted with a 4 mm collimator and treated with 40-80 Gy for maximal dose. Dose for pontine margin was always kept below 12 Gy. The median duration of the symptoms was 39.7 months (range, 1-192 months). There were 32 (48%) female and 33 male (52%).
     At last evaluation, a total of 43 patients (65%) with idiopathic trigeminal neuralgia reported pain relief. In these patients, thirty-three (51%) were reported without medications. Pain relief showed significant difference in MVD group from primary GKS and PRF (78% VS 59% and 50%)(P<0.001). Significant recurrence was noted in 23 patients, 16 of them received another gamma knife surgery and 9 had microvascular decompression. Mean time of recurrence was 12 months (from 6 to 48 months). New facial numbness was not significant difference. (P=0.24)
     This is a retrospective study.
     Gamma knife surgery established durable pain relief in 65% of patients with residual or recurrent trigeminal neuralgia.
     A primary treatment method is a factor to pain outcome.


Project Roles:

C. Huang (), S. Chiou (), H. Tu (), J. Chuang (), L. Lin ()