Results of three or more Gamma Knife radiosurgery procedures for recurrent trigeminal neuralgia

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  • 1 Department of Neurosurgery, University of California San Diego, La Jolla, California;
  • | 2 School of Medicine, University of Minnesota Twin Cities, Minneapolis, Minnesota;
  • | 3 School of Medicine, University of Pittsburgh, Pennsylvania;
  • | 4 Department of Neurosurgery, Massachusetts General Hospital, Boston;
  • | 5 Department of Public Health, School of Arts and Sciences, Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts;
  • | 6 Southern Methodist University, Dallas, Texas;
  • | 7 School of Medicine, Mercer University, Savannah, Georgia;
  • | 8 Hoag Gamma Knife Center, Newport Beach; and
  • | 9 San Diego Gamma Knife Center, San Diego, California
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OBJECTIVE

Gamma Knife radiosurgery (GKRS) is an established surgical option for the treatment of trigeminal neuralgia (TN), particularly for high-risk surgical candidates and those with recurrent pain. However, outcomes after three or more GKRS treatments have rarely been reported. Herein, the authors reviewed outcomes among patients who had undergone three or more GKRS procedures for recurrent TN.

METHODS

The authors conducted a multicenter retrospective analysis of patients who had undergone at least three GKRS treatments for TN between July 1997 and April 2019 at two different institutions. Clinical characteristics, radiosurgical dosimetry and technique, pain outcomes, and complications were reviewed. Pain outcomes were scored on the Barrow Neurological Institute (BNI) scale, including time to pain relief (BNI score ≤ III) and recurrence (BNI score > III).

RESULTS

A total of 30 patients were identified, including 16 women and 14 men. Median pain duration prior to the first GKRS treatment was 10 years. Three patients (10%) had multiple sclerosis. Time to pain relief was longer after the third treatment (p = 0.0003), whereas time to pain recurrence was similar across each of the successive treatments (p = 0.842). Complete or partial pain relief was achieved in 93.1% of patients after the third treatment. The maximum pain relief achieved after the third treatment was significantly better among patients with no prior percutaneous procedures (p = 0.0111) and patients with shorter durations of pain before initiation of GKRS therapy (p = 0.0449). New or progressive facial sensory dysfunction occurred in 29% of patients after the third GKRS treatment and was reported as bothersome in 14%. One patient developed facial twitching, while another experienced persistent lacrimation. No statistically significant predictors of adverse effects following the third treatment were found. Over a median of 39 months of follow-up, 77% of patients maintained complete or partial pain relief. Three patients underwent a fourth GKRS treatment, including one who ultimately received five treatments; all of them reported sustained pain relief at the extended follow-up.

CONCLUSIONS

The authors describe the largest series to date of patients undergoing three or more GKRS treatments for refractory TN. A third treatment may produce outcomes similar to those of the first two treatments in terms of long-term pain relief, recurrence, and adverse effects.

ABBREVIATIONS

BNI = Barrow Neurological Institute; GG = Gasserian ganglion; GKRS = Gamma Knife radiosurgery; MS = multiple sclerosis; MVD = microvascular decompression; REZ = root entry zone; SDGKC = San Diego Gamma Knife Center; TN = trigeminal neuralgia.

Supplementary Materials

    • Tables S1-S4 and Fig. S1 (PDF 1,107 KB)

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Contributor Notes

Correspondence Sharona Ben-Haim: University of California San Diego, La Jolla, CA. sbenhaim@health.ucsd.edu.

INCLUDE WHEN CITING Published online April 23, 2021; DOI: 10.3171/2020.10.JNS202323.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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