title: Gamma knife radiosurgery for recurrent trigeminal neuralgia.
abstract: OBJECTIVE
  Pain may fail to respond or may recur after initial gamma knife radiosurgery (GKS) for trigeminal neuralgia (TN). The authors examined their experience with performing a second GKS procedure in these patients.
  
  
  METHODS
  Twenty-nine patients underwent repeated GKS for TN at our institution between March 1997 and March 2002. Questionnaires were mailed to patients to assess the degree of their pain relief and the extent of facial numbness. Nineteen patients responded. All patients underwent repeated GKS involving a single 4-mm isocenter directed at the trigeminal nerve as it exited the brainstem (mean maximum dose 23.2 Gy). At a mean follow up of 13.5 months after the second procedure, 10 patients (53%) were pain free and medication free. Four patients (21%) were pain free but elected to continue medication in reduced dose, and two patients (11%) had incomplete but satisfactory pain control and were still taking medication. There was new-onset facial numbness in eight patients (42%), rated as tolerable in all instances.
  
  
  CONCLUSIONS
  Patients with facial numbness had a greater likelihood of being pain free than those with no sensory loss. The authors observed no cases of corneal anesthesia, keratitis, or deafferentation pain.
authors.affiliation: Department of Radiation Oncology, Foundation for Cancer Research and Education, Arizona Oncology Services, Phoenix, Arizona 85013, USA. andrew.shetter@bnaneuro.net
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Shetter
authors.forename: C Leland
authors.initials: CL
authors.lastname: Rogers
authors.forename: Francisco
authors.initials: F
authors.lastname: Ponce
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Fiedler
authors.forename: Kris
authors.initials: K
authors.lastname: Smith
authors.forename: Burton L
authors.initials: BL
authors.lastname: Speiser
mesh_terms: D005500:Follow-Up Studies; D006801:Humans; D011183:Postoperative Complications; D016634:Radiosurgery; D012008:Recurrence; D012086:Reoperation; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000601:surgery*