Long-term outcome of gamma knife radiosurgery for treatment of typical trigeminal neuralgia.
OBJECTIVE
To analyze the long-term outcomes of patients with typical trigeminal neuralgia treated with gamma knife radiosurgery (GKRS).


METHODS
A total of 62 consecutive patients with typical trigeminal neuralgia were treated with GKRS between 1998 and 2004. Of the 62 patients, 2 were lost to follow-up; the remaining 60 patients were followed for >12 months. The mean prescribed maximal dose was 79.7 Gy (range, 75-80), using a 4-mm shot.


RESULTS
Of the 60 patients, 48 were followed for >4 years. An additional 3 patients, followed for <4 years, experienced recurrent pain after a favorable initial response and were incorporated into the long-term response analysis. Of these 51 patients (mean age, 61 +/- 11 years; 37 women [72.5%]; and mean follow-up duration, 58 +/- 14 months), 46 (90.2%) responded to GKRS, as demonstrated by an improvement in their Barrow Neurological Institute pain intensity score. Of the 46 patients, 24 (52.2%) had pain recurrence. The actuarial recurrence-free survival rate was 84.8%, 76.1%, 69.6%, 63.0%, and 45.8% at 1, 2, 3, 4, and 5 years after radiosurgery, respectively. Patient age >70 years correlated with a favorable outcome in terms of pain recurrence after radiosurgery (hazard ratio, 0.125; 95% confidence interval, 0.016-0.975; p = .047) on multivariate analysis.


CONCLUSIONS
GKRS seems to be an effective treatment modality for patients with typical trigeminal neuralgia considering the initial response rate; however, fewer than one-half of patients might continue to benefit from GKRS after long-term follow-up. Elderly patients might be good candidates for radiosurgery considering the long-term durability of efficacy.
Han
Jung Ho
JH
Department of Neurosurgery, Seoul National University College of Medicine, 28 Yeongeon-dong, Chongno-gu, Seoul, Korea. gknife@plaza.snu.ac.kr
Kim
Dong Gyu
DG
Chung
Hyun-Tai
HT
Paek
Sun Ha
SH
Kim
Yong Hwy
YH
Kim
Chae-Yong
CY
Kim
Jin Wook
JW
Kim
Young-Hoon
YH
Jeong
Sang Soon
SS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D016634:Radiosurgery; D011879:Radiotherapy Dosage; D012008:Recurrence; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000601:surgery*