Repeat gamma knife radiosurgery for trigeminal neuralgia.
BACKGROUND
Although gamma knife radiosurgery (GKRS) has been shown to be safe and effective for the treatment of trigeminal neuralgia (TN), there are few studies that report the results of a second GKRS.


METHODS
Between May 22, 1998 and April 1, 2003, we treated 335 primary TN patients with GKRS. All received a maximum dose of 75 Gy to the cisternal trigeminal nerve. 45 patients with recurrent or persistent TN were treated with a maximum dose of 40 Gy at a second GKRS and were available for at least 6 months of follow-up.


RESULTS
Final pain relief (mean of 15 months after second GKRS) was 50% or greater in 28 of the 45 patients (62.2%). Patients who had no neurosurgical procedure prior to their first GKRS were more likely to have pain relief of 50% or greater following the second GKRS (p = 0.042). Significant new dysesthesias (score greater than 5 on a scale of 0-10) developed in 2 patients (4.4%).


CONCLUSIONS
Repeat GKRS has a good chance of relieving TN pain without complications and is more likely to relieve pain in those who did not have any procedure prior to their first GKRS.
Brisman
Ronald
R
Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University, New York Presbyterian Hospital, Columbia Presbyterian Medical Center, New York, NY, USA. rb36@columbia.edu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016634:Radiosurgery; D012086:Reoperation; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000601:surgery*