Functional Outcome Following Gamma Knife Radiosurgery For Trigeminal Neuralgia

Moksha Ranasinghe1, Omar Zalatimo1, Elana Farace1, James McInerney, MD2

1Penn State Hershey Medical Center, Hershey/ USA, 2Department of Neurosurgery Penn State Hershey College of Medicine

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

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     Stereotactic radiosurgery is an alternative to conventional surgery for treatment of trigeminal neuralgia.
     It has been well recognized as an effective treatment but the functional outcomes have not been studied.
     We retrospectively reviewed hospital charts of 71 patients treated at two centers (Lancaster General Hospital and Penn State Milton S. Hershey Medical Center) by two neurosurgeons. Of the patients, 46 were found to have at least one follow up thus far and were included in the study. Mean age was 65.8(range 41-96).
     A telephone survey and chart review were used to further investigate the functional improvement in these patients including dental outcomes, pain, and other influences on quality of life (QOL).
      The range of duration of symptoms prior to procedure was 5 months to 30 years. 16 patients had previous procedures performed with recurrence of symptoms. For three patients in the series, the most recent was the second gamma knife surgery procedure for trigeminal neuralgia . All patients received 80Gy to the 100% isodose level. 89% had resolution or decrease in frequency and intensity of their symptoms at follow up. Range of time to resolution of symptoms was immediate to 5 months. Of the patients that had long term resolution of symptoms there was recurrence on two patients -- one at 9 months and other at 2 years -- and these were controlled with medication adjustments. 68% of the patients were eventually weaned down  to a low dose on starting medications or were weaned off completely . One patient had new onset of V3 numbness following radiosurgery. Two patients had pre surgical facial numbness which remained unchanged. Six patients had extensive dental extractions prior to formal diagnosis of trigeminal neuralgia. and treatment with GKRS.  85.7% had teeth cleaning with a dentist within 6 months after the GKRS procedure.  Upon examining the quality of life(QOL) data, the physical health QOL scores were similar for patients with full or partial pain resolution but the mental health QOL scores were higher for patients with full pain resolution.
     This is a retrospective study.
     Stereotactic radiosurgery for trigeminal neuralgia is an effective treatment option with 89% of patients receiving benefit. The patients with prior failures from other modalities of treatment were less likely to benefit from stereotactic radiosurgery. 68% patients were able to be weaned off of starting medications.
     Several patients had extensive unnecessary dental procedures prior to receiving GKRS. Most patient felt comfortable receiving dental care following GKRS, without the fear of pain reactivation. Complete vs partial resolution of pain affected the patients'' mental health quality of life.


Project Roles:

M. Ranasinghe (), O. Zalatimo (), E. Farace (), J. McInerney ()