Treatment of essential trigeminal neuralgia with gamma knife surgery

Dusan Urgosik M.D., Ph.D. 1 , Roman Liscak M.D., Ph.D. 1 , Josef Novotny Jr. M.Sc., Ph.D. 1 , Josef Vymazal M.D., Ph.D. 1 and Vilibald Vladyka M.D., Ph.D. 1
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  • 1 Departments of Stereotactic and Radiation Neurosurgery, Medical Physics, and Radiology, Na Homolce Hospital, Prague, Czech Republic
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Object. The authors present the long-term follow-up results (minimum 5 years) of patients with essential trigeminal neuralgia (TN) who were treated with gamma knife surgery (GKS).

Methods. One hundred seven patients (61 females and 46 males) underwent GKS. The median follow up was time was 60 months (range 12–96 months). The target was the trigeminal root, and the maximum dose was 70 to 80 Gy. Repeated GKS was performed in 19 patients for recurrent pain, and the same dose was used.

Initial successful results were achieved in 96% of patients, with complete pain relief in 80.4%. Relief was achieved after a median latency of 3 months (range 1 day–13 months). Gamma knife surgery failed in 4% of patients. Pain recurred in 25% of patients after a median latent interval of 36 months (6–94 months). The initial success rate after a second GKS was 89% and 58% of patients were pain free. Pain relapse occurred in only one patient in this group. Hypesthesia was observed in 20% of patients after the first GKS and in 32% after the second GKS. The median interval to hypaesthesia was 35 months (range 3–94 months) after one treatment and 21 months (range 1–72 months) after a second treatment.

Conclusions. The initial success rate of pain relief was high and comparable to that reported in other studies. A higher than usual incidence of sensory impairment after GKS could be the long duration of follow-up study and due to the detailed neurological examination.

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Contributor Notes

Address reprint requests to: Dusan Urgosik, M.D., Ph.D., Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Roentgenova 2 150 30 Prague 5, Czech Republic. email:dusan.urgosik@homolka.cz.
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