title: Trigeminal neuralgia radiosurgery: the University of Pittsburgh experience.
abstract: The results of Gamma Knife stereotactic radiosurgery in the management of 51 patients who had typical trigeminal neuralgia were evaluated at the University of Pittsburgh. In all cases, a 4-mm isocenter was targeted at the proximal nerve at the root entry zone. The target dose varied from 60 to 90 Gy. Forty-four patients (86%) had undergone prior surgery. The mean follow-up after radiosurgery was 9.6 months (range, 2-29 months). The initial response rate was 86%. At the last follow-up, 19 patients (37%) had excellent control (pain free), 21 (41%) had good control (50-90% relief), and 11 (21%) had failed treatment. No patient developed further sensory loss or deafferentation pain. A maximum radiosurgery dose > or = 70 Gy was associated with a significantly greater chance for complete pain relief. Using magnetic resonance imaging stereotactic targeting, the proximal trigeminal nerve is an appropriate anatomic target for radiosurgery. Gamma Knife radiosurgery is a useful additional surgical approach in the management of medically or surgically refractory trigeminal neuralgia.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh, Pa., USA.
authors.forename: D
authors.initials: D
authors.lastname: Kondziolka
authors.forename: J C
authors.initials: JC
authors.lastname: Flickinger
authors.forename: L D
authors.initials: LD
authors.lastname: Lunsford
authors.forename: M
authors.initials: M
authors.lastname: Habeck
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010414:Pennsylvania; D011829:Radiation Dosage; D016634:Radiosurgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D012668:Trigeminal Ganglion / Q000601:surgery*; D014277:Trigeminal Neuralgia / Q000601:surgery*