Repeat Gamma Knife Radiosurgery For Recurrent Trigeminal Neuralgia – An Outcome Analysis

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

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     Trigeminal Neuralgia (TN) is characterized by intense, unilateral facial pain in the distribution of the trigeminal nerve. Although medications are often prescribed initially to treat TN, the pain does not always subside with pharmacological intervention alone. First introduced by Lars Leksell in 1951, Gamma Knife radiosurgery (GKR) has become a commonly used minimally invasive radiosurgical technique for managing TN. Numerous studies over the past decades have reported initial response rates between 50 and 96% for this treatment. Recurrent symptoms are a common complaint.
     Very few studies have considered the efficacy of repeat GKR for recurrent symptoms. There is controversy within the scientific community regarding the proper dosage and target localization for repeat GKR treatment. Long-term follow-up including, but not limited to, the incidence of side effects in patients with TN who require repeat radiosurgery is also lacking.
     Between April 1996 and October 2009, 413 patients were treated with GKR for TN at Florida Hospital’s Gamma Knife Center. Of these, 74 underwent repeat GKR for recurrent symptoms. To our knowledge, this represents the second largest population of TN patients requiring repeat GKR.
     We retrospectively evaluated the efficacy of repeat GKR for recurrent TN symptoms with statistical analysis of the clinical data.
     We report on the effectiveness of repeat GKR for recurrent TN symptoms, latency until symptom improvement, duration of pain relief, incidence of side effects, and on technical factors related to radiation dosage and target localization as they correlate with patient outcome.
     This is a retrospective study.
     Repeat GKR is an effective treatment for recurrent TN.
     Further analysis of similar clinical data gathered at other Gamma Knife centers is needed for comparison to establish appropriate guidelines for radiation dosage and target localization with regards to best patient outcome.


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