title: Repeat gamma knife radiosurgery for recurrent or refractory trigeminal neuralgia.
abstract: BACKGROUND
  Repeat gamma knife radiosurgery (GKRS) is considered to be an effective treatment for refractory or recurrent trigeminal neuralgia (TN).
  
  
  OBJECTIVE
  The purpose of this report was to demonstrate the relationship between the outcome of repeat GKRS and prior operative procedures on patients with recurrent or refractory TN.
  
  
  METHODS
  A retrospective analysis was performed on 34 patients with refractory or recurrent TN who had undergone repeat GKRS; 21 patients had undergone other types of procedures, 11 of whom had undergone more than three such procedures prior to radiosurgery. The maximum dose of the repeat procedure was between 60 and 75 Gy. The mean follow-up time was 21.6 months.
  
  
  METHODS
  The log-rank test and Fisher's exact test were used to analyze the data.
  
  
  RESULTS
  Excellent pain relief was achieved in 14 patients (41.2%) after repeat GKRS, while a successful outcome occurred in 29 of 34 patients (85.3%). Better pain relief occurred in the patients who did not have a prior procedure or who had undergone fewer than three prior procedures (P=0.042). Twenty-four of 25 patients (96.0%) who had recurrent pain had a successful operation and five of nine patients (55.6%) who did not have significant relief of pain after the first procedure had a successful operation. The difference was statistically significant (P<0.01). Only four patients had mild complications.
  
  
  CONCLUSIONS
  It is more likely to relieve pain in patients with recurrent or refractory TN who did not have a prior procedure or who had fewer than three procedures before undergoing their first GKRS. Moreover, it seems that patients who had a good response following the initial GKRS had better results after a repeat procedure.
authors.affiliation: Department of Neurosurgery, Tangdu Hospital, Institute for Functional Brain Disorders, Fourth Military Medical University, Xi'an, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Wang
authors.forename: Zhen-wei
authors.initials: ZW
authors.lastname: Zhao
authors.forename: Huai-zhou
authors.initials: HZ
authors.lastname: Qin
authors.forename: Wen-tao
authors.initials: WT
authors.lastname: Li
authors.forename: Hua
authors.initials: H
authors.lastname: Zhang
authors.forename: Jian-hai
authors.initials: JH
authors.lastname: Zong
authors.forename: Jian-Ping
authors.initials: JP
authors.lastname: Deng
authors.forename: Guo-dong
authors.initials: GD
authors.lastname: Gao
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 / Q000379:methods; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D055502:Secondary Prevention; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000517:prevention & control* / Q000601:surgery*