Repeat radiosurgery for idiopathic trigeminal neuralgia.
OBJECTIVE
Although frequently performed, the efficacy and safety of repeat trigeminal neuralgia radiosurgery is not well described.


METHODS
Between August 1997 and December 2002, 19 patients (9 men, 10 women) underwent repeat trigeminal neuralgia radiosurgery. The median interval between procedures was 16 months. The median dose (based on an output factor of 0.87 for the 4-mm collimator) for repeat radiosurgery was 76.1 Gy; the median additive dose was 163.1 Gy. Outcomes were defined as excellent (no pain, no medications), good (no pain, reduced medications), fair (>50% pain reduction), and poor. Median follow-up was 24 months.


RESULTS
Outcomes after repeat radiosurgery were excellent (n = 14, 74%), good (n = 1, 5%), fair (n = 3, 16%), and poor (n = 1, 5%). Two patients had recurrent pain at 7 and 22 months; 71% and 61% of patients had an excellent outcome at 1- and 2-years after radiosurgery, respectively. Eleven patients (58%) described facial parathesias (n = 3), numbness (n = 5) or dyesthesias (n = 3). Two patients (11%) developed corneal numbness. Nine of 11 patients (82%) with new trigeminal deficits had excellent outcomes at last follow-up compared with 3 of 8 patients (38%) with unchanged facial sensation (p = 0.07).


CONCLUSIONS
Repeat trigeminal neuralgia radiosurgery at the dosage described has better facial pain outcomes than primary radiosurgery. However, because the procedure is nonselective and the rate of bothersome numbness was relatively high (16%), dose reduction is recommended to reduce the morbidity of repeat trigeminal neuralgia radiosurgery.
Pollock
Bruce E
BE
Department of Neurological Surgery, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. pollock.bruce@mayo.edu
Foote
Robert L
RL
Link
Michael J
MJ
Stafford
Scott L
SL
Brown
Paul D
PD
Schomberg
Paula J
PJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods*; D011879:Radiotherapy Dosage; D012086:Reoperation; D014277:Trigeminal Neuralgia / Q000601:surgery*