Gamma Knife stereotactic radiosurgical treatment of idiopathic trigeminal neuralgia: long-term outcome and complications

Neurosurg Focus. 2007;23(6):E8. doi: 10.3171/FOC-07/12/E8.

Abstract

Object: Stereotactic radiosurgery (SRS) with the Gamma Knife (GK) is a rapidly emerging surgical modality in the management of medically refractory idiopathic trigeminal neuralgia (TN). The current study examines the long-term outcome in patients with drug-resistant idiopathic TN who underwent GK surgery at the authors' institution.

Methods: One hundred and six consecutive patients (38 men and 68 women) with proven medically refractory idiopathic TN were included in this retrospective study. Their ages were 41-82 years (mean 72.3 years). All patients underwent SRS with prescribed maximal radiation doses ranging from 70 to 85 Gy. Isocenters 1-3 were used and plugging was used selectively. The follow-up period was 12-72 months (mean 34.3 months). The patients were divided into 2 groups according to their history of previous surgery.

Results: The initial response rate in patients with no history of previous surgery was 92.9%; in those who had undergone previous surgery, the initial response rate was 85.7%. At the end of the 1st posttreatment year, an excellent outcome was achieved in 82.5% of patients who had not had previous surgery, and in 69.4% of those who had. The respective outcome rates for the 2nd posttreatment year were 78 and 63.5%, respectively. The most common complication was the development of persistent paresthesia, which occurred in 15.8% of patients with no previous surgery and 16.3% of those with previous surgery.

Conclusions: Stereotactic radiosurgery with the GK is a safe and effective treatment option for patients with medically refractory idiopathic TN.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Pain Measurement
  • Prospective Studies
  • Radiosurgery / methods*
  • Retrospective Studies
  • Treatment Outcome*
  • Trigeminal Neuralgia / radiotherapy*
  • Trigeminal Neuralgia / surgery*