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Related Experiment Videos

Repeat radiosurgery for refractory trigeminal neuralgia.

Toshinori Hasegawa1, Douglas Kondziolka, Richard Spiro

  • 1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.

Neurosurgery
|February 14, 2002
PubMed
Summary

Repeat stereotactic radiosurgery for trigeminal neuralgia offers similar pain relief to the initial procedure. While effective, a second gamma knife radiosurgery increases the risk of new sensory symptoms but shows no other significant morbidity.

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Area of Science:

  • Neurosurgery
  • Neurology
  • Radiation Oncology

Background:

  • Stereotactic radiosurgery (SRS) is a minimally invasive treatment for trigeminal neuralgia.
  • Outcomes of repeat SRS for refractory trigeminal neuralgia are not well-established.
  • This study investigates pain relief and morbidity following a second SRS procedure.

Purpose of the Study:

  • To evaluate the efficacy and safety of repeat gamma knife radiosurgery (GKRS) in patients with trigeminal neuralgia.
  • To compare outcomes of the second GKRS procedure with the initial SRS treatment.
  • To assess the incidence of new sensory symptoms and other morbidities after repeat SRS.

Main Methods:

  • Retrospective analysis of 31 patients undergoing a second GKRS for trigeminal neuralgia.

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  • Median follow-up of 42.7 months (first SRS) and 20.4 months (second SRS).
  • Patients had prior treatments including microvascular decompression, radiofrequency rhizotomy, glycerol rhizotomy, and balloon compression; median doses were 75 Gy (first SRS) and 64 Gy (second SRS).

    • Main Results:

    • After the second SRS, 48% of patients achieved complete pain relief (excellent or good response).
    • Initial responses to the first SRS were excellent (13 patients) or good (3 patients).
    • New sensory symptoms occurred in 7.4% after the first SRS and 12.7% after the second SRS; no other significant morbidity was observed.

    Conclusions:

    • Repeat SRS provides comparable pain relief to the initial procedure, even with a reduced radiation dose.
    • The risk of developing new sensory symptoms is elevated after a second SRS procedure.
    • Recommended target dose for repeat SRS is 50-60 Gy, delivered to an anterior trigeminal target near the nerve entry zone.