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Gamma knife radiosurgery for recurrent trigeminal neuralgia
Andrew G Shetter1, C Leland Rogers, Francisco Ponce
1Department of Radiation Oncology, Foundation for Cancer Research and Education, Arizona Oncology Services, Phoenix, Arizona 85013, USA. andrew.shetter@bnaneuro.net
Journal of Neurosurgery
|January 1, 2003
Summary
A second gamma knife radiosurgery (GKS) for trigeminal neuralgia (TN) can provide significant pain relief. Over half of patients were pain-free and medication-free after repeated GKS, with tolerable side effects.
Area of Science:
- Neurosurgery
- Neurology
- Radiotherapy
Background:
- Trigeminal neuralgia (TN) pain can be refractory to initial treatments.
- Gamma Knife radiosurgery (GKS) is an established treatment for TN.
- Recurrence or lack of response necessitates further therapeutic options.
Purpose of the Study:
- To evaluate the efficacy and safety of a second GKS procedure for patients with recurrent or refractory TN.
- To assess pain relief, medication requirements, and adverse effects following repeat GKS.
Main Methods:
- Retrospective analysis of 29 patients who underwent a second GKS for TN between 1997 and 2002.
- Standardized questionnaires assessed pain relief and facial numbness.
- All patients received a single 4-mm isocenter GKS targeting the trigeminal nerve root entry zone with a mean maximum dose of 23.2 Gy.
Main Results:
- At a mean follow-up of 13.5 months, 53% of responders were pain-free and medication-free.
- An additional 21% were pain-free on reduced medication, and 11% had satisfactory pain control.
- New-onset facial numbness occurred in 42% of patients, all rated as tolerable. No corneal anesthesia, keratitis, or deafferentation pain was observed.
Conclusions:
- Repeated GKS offers a viable treatment option for select patients with TN who did not achieve durable pain relief from initial GKS.
- Pre-existing facial numbness may predict a better outcome after repeat GKS.
- Repeat GKS appears safe, with a low incidence of severe complications.