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Gamma knife radiosurgery for trigeminal neuralgia
Sean A McNatt1, Cheng Yu, Steven L Giannotta
1Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA. mcnatt@usc.edu
Neurosurgery
|May 28, 2005
Summary
Gamma knife radiosurgery effectively relieved trigeminal neuralgia pain in 61% of patients. This treatment offers durable pain relief for medically refractory cases, though long-term recurrence and complication rates require further study.
Area of Science:
- Neurosurgery
- Radiation Oncology
Background:
- Trigeminal neuralgia (TN) is a debilitating neuropathic facial pain disorder.
- Medically refractory TN often requires advanced treatment modalities.
Purpose of the Study:
- To evaluate the efficacy and safety of Gamma Knife radiosurgery (GKRS) for treating trigeminal neuralgia.
Main Methods:
- 49 patients with TN underwent GKRS targeting the trigeminal root entry zone.
- Doses were delivered using a 4-mm collimator to the 50% isodose line (40 Gy), with pons dose limited to 12 Gy.
- Outcomes assessed included pain relief (Barrow Neurological Institute score), symptom recurrence, and treatment toxicity over a median follow-up of 49 months.
Main Results:
- 61% of patients (27/49) achieved pain relief (Barrow score IIIb or less).
- 32% experienced complete pain relief without medication.
- Pain recurrence was observed in 23% of patients, with a mean time to recurrence of 9.6 months. Mild dysesthesias and numbness were reported by 18% and 29% of patients, respectively.
Conclusions:
- GKRS provides durable pain relief for a majority of patients with medically refractory idiopathic trigeminal neuralgia.
- Long-term follow-up is essential to fully ascertain late complication and recurrence rates.