Gamma Knife radiosurgery for relapsing trigeminal neuralgia following microvascular decompression

Alexander C Horn ¹, Arian Kolahi Sohrabi ¹, Michael D Chan ²

⁰Departments of1Neurosurgery and.

Journal of Neurosurgery +

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November 29, 2024

View abstract on PubMed

Summary

Salvage Gamma Knife radiosurgery (GKRS) effectively treats recurrent trigeminal neuralgia (TN) after microvascular decompression (MVD). Post-operative facial numbness and a good initial pain response predict longer-lasting relief, with a manageable complication rate.

Area Of Science

Neurosurgery
Radiation Oncology
Pain Management

Background

Trigeminal neuralgia (TN) is a debilitating neuropathic pain condition.
Microvascular decompression (MVD) is a primary surgical treatment for TN.
Recurrence of TN after MVD necessitates alternative treatment strategies.

Purpose Of The Study

To evaluate the efficacy and safety of salvage Gamma Knife radiosurgery (GKRS) for TN patients with recurrent pain post-MVD.
To determine the response rate, pain relief durability, and complication profile of salvage GKRS.
To identify predictors of pain relapse after salvage GKRS.

Main Methods

Retrospective analysis of patients with TN1 or TN2 who underwent salvage GKRS post-MVD.
Pain assessment using the Barrow Neurological Institute (BNI) pain intensity score.
Kaplan-Meier analysis for durability of pain relief and Cox regression for relapse predictors.

Main Results

83.1% of patients achieved initial pain relief (BNI scores I-III) after salvage GKRS.
Median time to relapse was 1.75 years; 1, 2, and 5-year relapse-free rates were 77%, 45.9%, and 30.7%.
Pre-MVD radiofrequency ablation decreased initial response; post-operative facial numbness and better initial pain response predicted durable relief.

Conclusions

Salvage GKRS is an effective, noninvasive option for recurrent TN after MVD, offering comparable efficacy to primary treatments.
The complication profile of salvage GKRS is favorable compared to repeat MVD.
Facial numbness and a strong initial pain response are associated with more durable pain relief.

Keywords:

Gamma Knife radiosurgery functional neurosurgery microvascular decompression pain stereotactic radiosurgery trigeminal neuralgia