• Stylianons Pikis, Adomas Bunevicius, Joseph Donahue, Karen Lavezzo, Greg Patterson, Zhiyuan Xu, and Jason Sheehan.
• Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
• World Neurosurg. 2021 Sep 1; 153: e220-e225.

BackgroundGamma Knife radiosurgery (GKRS) is a safe and effective treatment option for trigeminal neuralgia (TN). However, there is no objective, noninvasive tool to identify nonresponders or late responders to GKRS and to facilitate longitudinal patient management. We hypothesized that diffusivity metrics obtained 3 months after GKRS may correlate with response to treatment.MethodsSixteen patients with TN treated with GKRS underwent preprocedural and 3-month postprocedural 3-T magnetic resonance imaging of the brain. Diffusion tensor metrics of axial diffusivity, radial diffusivity, and fractional anisotropy were extracted from the pontine segments, the root entry zones, and the distal cisternal segments of both trigeminal nerves. Diffusivity metrics at the 3-month post-GKRS time point were compared with pain relief at last follow-up. Favorable response to GKRS was defined as pain intensity of I-III on the Barrow Neurological Institute scale.ResultsThe median clinical follow-up was 11 months (range 3-18 months). Patients with favorable response to GKRS at last follow-up had lower mean fractional anisotropy values at the pontine segment (P = 0.04) and increased mean radial diffusivity values at the root entry zones (P = 0.032) of the treated trigeminal nerve on the 3-month diffusion tensor imaging sequences as compared with the nonresponders.ConclusionsDiffusivity metrics changes on the treated trigeminal nerve at the 3-month time point after GKRS for TN correlated with pain relief at last follow-up. Further, well-designed studies are warranted to establish the clinical application of diffusion tensor imaging as a noninvasive, prognostic tool in patients with TN managed with GKRS.Copyright © 2021 Elsevier Inc. All rights reserved.

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