Gamma Knife Radiosurgery for Tumor-Related Trigeminal Neuralgia: A Single-Center Retrospective Study

Tumor-related trigeminal neuralgia (TN) is a challenging condition to manage that can be treated with gamma knife radiosurgery (GKRS) by targeting the tumor, the trigeminal nerve, or both. However, data regarding the efficacy of this treatment are somewhat limited. The aim of this study was to report outcomes of GKRS for tumor-related TN from a cohort study.

Retrospective review of our GKRS database identified 41 patients with benign tumor-related TN treated with GKRS between 2014 and 2024. Background medical history, treatment outcomes and complications, and dosimetric data were obtained by chart review.

The tumor, the trigeminal nerve alone, or a combination of both was targeted in 28, 7, and 6 patients, for a total of 47 GKRS procedures. Eight (24%) patients had pain control before GKRS targeting the tumor. Thirty (88%) and 11 (85%) patients had pain control after GKRS targeting the tumor and the trigeminal nerve, respectively. After a median follow-up of 63 months, pain recurred in 8 (24%) and 3 (23%) patients in the two groups. After tumor- and nerve-targeted GKRS, estimated rates of pain control at 1, 4, 7, and 10 years were 82%, 69%, 56%, and 56%, and 77%, 67%, 50%, and 50%, respectively. When GKRS targeting the tumor and the trigeminal nerve was considered as part of the same treatment, estimated rates of pain control at 1, 4, 7, and 10 years were 83%, 75%, 71%, and 71%. After tumor- and nerve-targeted GKRS, respectively, 5 (15%) and 3 (23%) patients developed persistent non-bothersome facial hypesthesia.

GKRS targeting the tumor is an effective, well-tolerated treatment for patients with tumor-related TN. More durable relief is achieved in some patients with second-stage GKRS targeting the trigeminal nerve but with additional facial sensory disturbances.