title: Prospective controlled trial of gamma knife surgery for essential trigeminal neuralgia.
abstract: OBJECTIVE
  Stereotactic radiosurgery is an alternative to conventional surgery for the treatment of trigeminal neuralgia. The authors conducted a prospective evaluation of the safety and efficacy of this method in a large series of patients.
  
  
  METHODS
  A total of 100 patients presenting with trigeminal neuralgia were treated and followed up for a minimum of 12 months. The mean age was 68.2 years; 54 patients were male, and 46 were female. Seven had a history of multiple sclerosis, and 42 had already received conventional surgical treatment for trigeminal neuralgia. The intervention consisted of gamma knife surgery to the retrogasserian cisternal portion of the fifth cranial nerve. The median dose used at the maximum was 85 Gy (range 70-90 Gy). The number and intensity of pain attacks were recorded by the patient from 3 months before radiosurgery to a minimum of 12 months after treatment. Before and a minimum of 12 months after treatment, the patient completed a quality-of-life questionnaire. Neurological examination and quantitative sensory testing to evaluate sensory perception were performed by an independent neurologist over this same time period. At the last visit 83 of 100 patients were reported to be pain free. Fifty-eight of these 83 patients had stopped taking medication during the study. All quality-of-life parameters were improved (p < 0.001). Six patients reported facial paresthesia, and four patients reported hypesthesia. These symptoms were classified as mild. None of the complications reported for other techniques were observed.
  
  
  CONCLUSIONS
  Radiosurgery is a safe and effective alternative treatment for trigeminal neuralgia and is associated with a particularly low rate of hypesthesia.
authors.affiliation: Departments of Functional Neurosurgery and Neurology, Timone University Hospital, Marseille, France. jregis@ap-hm.fr
authors.forename: Jean
authors.initials: J
authors.lastname: Régis
authors.forename: Philippe
authors.initials: P
authors.lastname: Metellus
authors.forename: Motohiro
authors.initials: M
authors.lastname: Hayashi
authors.forename: Philippe
authors.initials: P
authors.lastname: Roussel
authors.forename: Anne
authors.initials: A
authors.lastname: Donnet
authors.forename: Françoise
authors.initials: F
authors.lastname: Bille-Turc
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D016634:Radiosurgery; D020127:Recovery of Function / Q000502:physiology; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000503:physiopathology / Q000601:surgery*