[Gamma Knife radiosurgery treatment of trigeminal neuralgia and atypical facial pain].
BACKGROUND
Typical trigeminal neuralgia (TTN) is a condition that is treated initially by pharmacological means and, if this fails, with different surgical techniques. With the advent of radiosurgery a relatively bloodless form of treatment with low toxicity and good results has become available and can be considered for use as the first choice procedure.


OBJECTIVE
Our aim was to report the findings obtained from treating this pathology using Gamma Knife radiosurgery in order to assess the possibility of using it for patients with neuralgia associated to multiple sclerosis (MS) or who have atypical facial pain (AFP). We also assessed the patients who were re-treated owing to recurrence or persistence.


METHODS
The sample was made up of 74 patients, including seven cases of lesions in the brain stem at the nerve entry point, 45 cases of associated vascular compression, 15 cases of AFP and eight cases of re-treatment. The median maximum dose was 84 Gy (60.2-120). The mean follow-up time was 23.26 months (1-97.83).


RESULTS
Of those with TTN, 76.2% of subjects had no pain at the end of the study (75% in cases of second treatments, 69% in cases of associated vascular compression, 52% of those with prior interventions and 43% with MS), and 33% in the case of AFP. The mean time elapsed before pain disappeared was 4.34 months (0-23.72). Sensitivity was newly affected in 20.3% of patients with TTN or AFP.


CONCLUSIONS
Gamma Knife radiosurgery is a first choice therapeutic option for use with patients who have TTN or AFP, as well as in cases of neuralgia associated to MS. It can also be considered for use as re-treatment with a tolerable rate of morbidity.
Martínez-Moreno
N E
NE
Unidad de Radiocirugía y Neurocirugía Funcional, Hospital Ruber Internacional, Madrid, Spain. nuriaemartinez@terra.es
Martínez-Alvarez
R
R
Rey-Portolés
G
G
Gutiérrez-Sárraga
J
J
Burzaco-Santurtún
J
J
Bravo
G
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000378:metabolism; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods; D005157:Facial Pain / Q000601:surgery*; D005682:Gadolinium / Q000378:metabolism; D006801:Humans; D008875:Middle Aged; D016634:Radiosurgery / Q000295:instrumentation* / Q000379:methods; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D014277:Trigeminal Neuralgia / Q000473:pathology / Q000601:surgery*
D003287:Contrast Media; D005682:Gadolinium