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Stereotactic radiosurgery for trigeminal neuralgia: a multiinstitutional study using the gamma unit
D Kondziolka1, L D Lunsford, J C Flickinger
1Department of Neurological Surgery, University of Pittsburgh, Pennsylvania, USA.
Journal of Neurosurgery
|June 1, 1996
Summary
Gamma knife radiosurgery effectively manages trigeminal neuralgia, offering pain relief for most patients. Higher doses (≥70 Gy) significantly improve pain-free outcomes, with minimal side effects.
Area of Science:
- Neurosurgery
- Radiation Oncology
Background:
- Trigeminal neuralgia is a debilitating neuropathic pain condition.
- Medically or surgically refractory cases require advanced treatment options.
Purpose of the Study:
- To evaluate Gamma Knife stereotactic radiosurgery for trigeminal neuralgia management.
- To assess technique, dose parameters, and patient outcomes.
Main Methods:
- Multi-institutional study involving 50 patients with trigeminal neuralgia.
- Single 4-mm isocenter targeting the trigeminal nerve root entry zone.
- Doses ranged from 60 to 90 Gy, with a median follow-up of 18 months.
Main Results:
- 58% achieved excellent pain control (pain-free), 36% good control (50%-90% relief).
- Median time to pain relief was 1 month.
- Doses of 70 Gy or greater significantly increased complete pain relief (72% vs. 9%).
- 6% experienced transient facial paresthesia; no other deficits or deafferentation pain reported.
Conclusions:
- Gamma Knife radiosurgery is an effective treatment for refractory trigeminal neuralgia.
- The trigeminal nerve root entry zone is a suitable target.
- Higher radiosurgical doses correlate with better pain relief.
