• Oper Neurosurg (Hagerstown) · Jun 2020

    Effectiveness of Gamma Knife Radiosurgery in the Treatment of Refractory Trigeminal Neuralgia: A Case Series.

    • Sherwin Tavakol, Anna Jackanich, Ben A Strickland, Michael Marietta, Kristine Ravina, Cheng Yu, Eric L Chang, Steven Giannotta, and Gabriel Zada.
    • Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
    • Oper Neurosurg (Hagerstown). 2020 Jun 1; 18 (6): 571-576.

    BackgroundMedical management is the first line of treatment for trigeminal neuralgia (TN). Patients with medically refractory TN may undergo a variety of invasive surgical interventions with varying success rates. Management of TN refractory to both medical and surgical intervention remains somewhat controversial.ObjectiveTo assess the effectiveness of Gamma Knife radiosurgery (GKRS; Elekta Instruments AB) for medically refractory TN.MethodsA retrospective review was conducted for 57 cases (47 patients) who underwent GKRS for refractory TN at our institution between 2005 and 2018. TN pain outcomes were evaluated using the Barrow Neurological Institute (BNI) Pain Scale. A good outcome was defined by post-GKRS BNI score of I-III, whereas treatment failure was defined BNI score IV-V.ResultsOf the total 57 GKRS procedures, 47 (82.5%) had good outcomes. A total of 22 patients (46.8%) experienced complete pain relief off medications (BNI I). The average time to pain relief was 30 d (range 1-120 d). Prior invasive surgical treatment for TN was not found to have a significant impact on GKRS outcomes (P = .32). Target and treatment volumes were not found to correlate significantly with GKRS outcomes (.47 and .47, respectively). Complications included 2 cases (4.2%) of facial numbness. A total of 37 patients (78.7%) did not have any additional invasive surgical interventions following GKRS treatment.ConclusionGKRS is a safe and effective treatment modality for both medically and surgically refractory TN. Complete symptom relief was possible in patients with prior surgical or GKRS treatments. Recurrent symptoms following surgery or GKRS should not exclude a patient from future GKRS consideration.Copyright © 2019 by the Congress of Neurological Surgeons.

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