Clinical outcomes of linear accelerator-based stereotactic radiosurgery for trigeminal neuralgia

Trigeminal neuralgia (TN) is a severely disabling facial pain disorder. When medical treatment fails, stereotactic radiosurgery (SRS) is an established option. The Gamma Knife is widely used but not always available. This study assessed the efficacy and safety of linear accelerator (LINAC)-based SRS, a more accessible alternative, for the management of classical or idiopathic TN.

We conducted a retrospective review of 30 consecutive patients treated between January 2017 and April 2022 in a single oncology center. All patients received SRS delivered with a LINAC targeting the retrogasserian portion of the trigeminal nerve with doses of 80-90 Gy. Demographic, clinical, and treatment variables were collected. Pain outcomes were evaluated using the Barrow Neurological Institute pain scale.

The mean age was 57.2 years, with a female predominance. The mandibular branch was the most frequently involved division. Pain relief was achieved in 90% of patients, with a mean onset at 3.1 months. Complete pain relief was obtained in 60% of cases. Pain recurrence occurred in 30% (9/30) of patients within 2-24 months; three benefited from repeat radiosurgery. Adverse effects were mild, mainly facial hypoesthesia and ocular irritation, with no hearing impairment or dry eye.

LINAC -based SRS is an effective and safe option for refractory TN. Its accessibility makes it a valuable alternative to Gamma Knife, particularly in centers without dedicated neurosurgical platforms and in low- and middle-income countries.