title: Operative management of patients with radiosurgery-related trigeminal neuralgia: analysis of the surgical morbidity and pain outcome.
abstract: OBJECTIVE
  Trigeminal neuralgia (TGN) occurring after radiosurgical treatment of cerebellopontine or petroclival tumors may be very difficult to control. Our aim was to determine the efficacy of neurosurgical treatment in regards to pain control and to evaluate the procedure-related complication and morbidity rates.
  
  
  METHODS
  Retrospective study of a series of operated patients with radiosurgery-induced TGN. The primary goal of the surgery was to inspect and decompress the trigeminal nerve; the second goal was to remove the tumor remnant completely, if safely feasible. The main outcome measures were pain control, time to onset of pain relief and its duration, occurrence of new neurological deficits or worsening of the existing one and completeness of tumor removal.
  
  
  RESULTS
  The four patients met the inclusion criteria: 2 with vestibular schwannomas, 1 with petroclival meningioma and 1 with an epidermoid. TGN occurred 12-60 months after radiosurgery (mean 39 months). At presentation the pain attacks occurred multiple timesdaily and lasted from a few seconds to 2-3min. The Complete tumor removal via the retrosigmoid approach was achieved in all cases. There were no major operative complications or persistent morbidity, besides one patient with trochlear nerve palsy. All patients experienced immediate pain relief after surgery. At follow-up (median duration - 42.5 months) the three patients reported complete pain resolution. One patient had occasional slight pain but did not need any medications.
  
  
  CONCLUSIONS
  Surgery is safe and effective treatment option of patients with intractable radiosurgery-induced TGN. It leads to excellent pain control and is curative in regards to the neoplastic disease.
authors.affiliation: International Neuroscience Institute, Rudolf Pichlmayr Str. 4, Hannover 30625, Germany. Electronic address: gerganov@ini-hannover.de.
authors.forename: Venelin M
authors.initials: VM
authors.lastname: Gerganov
authors.affiliation: International Neuroscience Institute, Rudolf Pichlmayr Str. 4, Hannover 30625, Germany. Electronic address: mario.giordano@alice.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Giordano
authors.affiliation: International Neuroscience Institute, Rudolf Pichlmayr Str. 4, Hannover 30625, Germany. Electronic address: Elolfelolf@ini-hannover.de.
authors.forename: Erck
authors.initials: E
authors.lastname: Elolf
authors.affiliation: International Neuroscience Institute, Rudolf Pichlmayr Str. 4, Hannover 30625, Germany. Electronic address: Osamahalmarzooq@ini-hannover.de.
authors.forename: Almarzooq
authors.initials: A
authors.lastname: Osamah
authors.affiliation: International Neuroscience Institute, Rudolf Pichlmayr Str. 4, Hannover 30625, Germany. Electronic address: Amirasamii@ini-hannover.de.
authors.forename: Samii
authors.initials: S
authors.lastname: Amir
authors.affiliation: International Neuroscience Institute, Rudolf Pichlmayr Str. 4, Hannover 30625, Germany. Electronic address: Madjidsamii@ini-hannover.de.
authors.forename: Samii
authors.initials: S
authors.lastname: Madjid
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D016634:Radiosurgery / Q000009:adverse effects*; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000209:etiology / Q000601:surgery*
keywords: Cerebellopontine angle; Gamma knife; Radiosurgery; Trigeminal neuralgia; Vestibular schwannoma