Repeat gamma knife radiosurgery for recurrent or refractory trigeminal neuralgia.
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.
Wang
Liang
L
Department of Neurosurgery, Tangdu Hospital, Institute for Functional Brain Disorders, Fourth Military Medical University, Xi'an, China.
Zhao
Zhen-wei
ZW
Qin
Huai-zhou
HZ
Li
Wen-tao
WT
Zhang
Hua
H
Zong
Jian-hai
JH
Deng
Jian-Ping
JP
Gao
Guo-dong
GD
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*