Results of radiosurgery for trigeminal neuralgia: Ankara experience

The purpose of this retrospective study is to demonstrate the effectiveness of Gamma Knife radiosurgery for essential trigeminal neuralgia (TGN) and assess the long-term outcome in a cohort from Turkey.

From 2004 to 2011, 93 cases of essential TGN were treated with single radiosurgery (RS). Female:male ratio was 45:48 and the mean age of the population was 57.06 years. Mean suffering time before treatment was 88.26 months. V2 + V3 was the most effected branch. 38.7% of the cases had no previous invasive procedures. Each case received doses ranging from 70 to 90 Gy in a target located at the pontine trigeminal root entry zone of the trigeminal nerve. Statistical analyses were performed to evaluate the outcome and factors leading to outcome status.

The median follow-up period was 28 months. Of the cases 31.2% had poor outcome related to treatment failure after single RS session. The excellent and good outcomes were achieved in 29% and 39.8% of patients, respectively. The probability of maintaining pain relief was calculated as 67% at 36 months and 58% at 72 months. The only complication encountered was facial dysesthesia and was positive in 68.8% of patients. The presence of facial dysesthesia was significantly correlated with better outcomes. In this study, no other factor was determined to have significant influence on outcome.

RS treatment for TGN is safe and effective. A multicenter, prospective, randomized controlled trial is needed to determine a guideline for better treatment protocols.