title: Long-term outcome of gamma knife radiosurgery for treatment of typical trigeminal neuralgia.
abstract: 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.
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, 28 Yeongeon-dong, Chongno-gu, Seoul, Korea. gknife@plaza.snu.ac.kr
authors.forename: Jung Ho
authors.initials: JH
authors.lastname: Han
authors.forename: Dong Gyu
authors.initials: DG
authors.lastname: Kim
authors.forename: Hyun-Tai
authors.initials: HT
authors.lastname: Chung
authors.forename: Sun Ha
authors.initials: SH
authors.lastname: Paek
authors.forename: Yong Hwy
authors.initials: YH
authors.lastname: Kim
authors.forename: Chae-Yong
authors.initials: CY
authors.lastname: Kim
authors.forename: Jin Wook
authors.initials: JW
authors.lastname: Kim
authors.forename: Young-Hoon
authors.initials: YH
authors.lastname: Kim
authors.forename: Sang Soon
authors.initials: SS
authors.lastname: Jeong
mesh_terms: 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*