Gamma Knife stereotactic radiosurgical treatment of idiopathic trigeminal neuralgia: long-term outcome and complications.
OBJECTIVE
Stereotactic radiosurgery (SRS) with the Gamma Knife (GK) is a rapidly emerging surgical modality in the management of medically refractory idiopathic trigeminal neuralgia (TN). The current study examines the long-term outcome in patients with drug-resistant idiopathic TN who underwent GK surgery at the authors' institution.


METHODS
One hundred and six consecutive patients (38 men and 68 women) with proven medically refractory idiopathic TN were included in this retrospective study. Their ages were 41-82 years (mean 72.3 years). All patients underwent SRS with prescribed maximal radiation doses ranging from 70 to 85 Gy. Isocenters 1-3 were used and plugging was used selectively. The follow-up period was 12-72 months (mean 34.3 months). The patients were divided into 2 groups according to their history of previous surgery.


RESULTS
The initial response rate in patients with no history of previous surgery was 92.9%; in those who had undergone previous surgery, the initial response rate was 85.7%. At the end of the 1st posttreatment year, an excellent outcome was achieved in 82.5% of patients who had not had previous surgery, and in 69.4% of those who had. The respective outcome rates for the 2nd posttreatment year were 78 and 63.5%, respectively. The most common complication was the development of persistent paresthesia, which occurred in 15.8% of patients with no previous surgery and 16.3% of those with previous surgery.


CONCLUSIONS
Stereotactic radiosurgery with the GK is a safe and effective treatment option for patients with medically refractory idiopathic TN.
Fountas
Kostas N
KN
Departments of Neurosurgery, Medical College of Georgia, Augusta, Georgia, USA. knfountasmd@excite.com
Smith
Joseph R
JR
Lee
Gregory P
GP
Jenkins
Patrick D
PD
Cantrell
Rebecca R
RR
Sheils
W Chris
WC
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; D011446:Prospective Studies; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000532:radiotherapy* / Q000601:surgery*