title: Trigeminal neuralgia treatment outcomes following Gamma Knife radiosurgery with a minimum 3-year follow-up.
abstract: OBJECTIVE
  Effective short-term outcomes have been well documented for trigeminal neuralgia (TN) patients treated with Gamma Knife radiosurgery (GKRS) with reported success rates of 70-90 % with median follow-up intervals of 19-75 months. Fewer series, however, have described uniform long-term follow-up data. In this study, we report our long-term institutional outcomes in patients treated with GKRS after a minimum follow-up of 36 months.
  
  
  METHODS
  Thirty-six consecutive patients with medically intractable TN received a median radiation dose of 45 Gy applied with a single 4-mm isocenter to the affected trigeminal nerve. Follow-up data were obtained by clinical examination and telephone questionnaire. Outcome results were categorized based on the Barrow Neurological Institute (BNI) pain scale with BNI I-III considered to be good outcomes and BNI IV-V considered as treatment failure. BNI facial numbness score was used to assess treatment complications.
  
  
  RESULTS
  The incidence of early pain relief was high (80.5 %) and relief was noted in an average of 1.6 months after treatment. At minimum follow-up of 3 years, 67 % were pain free (BNI I) and 75 % had good treatment outcome. At a mean last follow-up of 69 months, 32 % were free from any pain and 63 % were free from severe pain. Bothersome posttreatment facial numbness was reported in 11 % of the patients. A statistically significant correlation was found between age and recurrence of any pain with age >70 predicting a more favorable outcome after radiosurgery.
  
  
  CONCLUSIONS
  The success rate of GKRS for treatment of medically intractable TN declines over time with 32 % reporting ideal outcome and 63 % reporting good outcome. Patients older than age 70 are good candidates for radiosurgery. This data should help in setting realistic expectations for weighing the various available treatment options.
authors: Department of Radiation Oncology, Medstar Georgetown University Hospital, 3800 Reservoir Rd., NW, Washington, DC 20007 USA.
authors: Sana D
authors: SD
authors: Karam
authors: Department of Radiation Oncology, Medstar Georgetown University Hospital, 3800 Reservoir Rd., NW, Washington, DC 20007 USA.
authors: Alexander
authors: A
authors: Tai
authors: Department of Radiation Oncology, Medstar Georgetown University Hospital, 3800 Reservoir Rd., NW, Washington, DC 20007 USA.
authors: Margaux
authors: M
authors: Wooster
authors: Department of Radiation Oncology, Medstar Georgetown University Hospital, 3800 Reservoir Rd., NW, Washington, DC 20007 USA.
authors: Abdul
authors: A
authors: Rashid
authors: Department of Radiation Oncology, Medstar Washington Hospital Center, Washington, DC USA.
authors: Rosanna
authors: R
authors: Chen
authors: Department of Radiation Oncology, Medstar Georgetown University Hospital, 3800 Reservoir Rd., NW, Washington, DC 20007 USA.
authors: Nimrah
authors: N
authors: Baig
authors: Department of Radiology, Medstar Georgetown University Hospital, Washington, DC USA.
authors: Ann
authors: A
authors: Jay
authors: Department of Radiation Oncology, Medstar Georgetown University Hospital, 3800 Reservoir Rd., NW, Washington, DC 20007 USA.
authors: K William
authors: KW
authors: Harter
authors: Department of Radiation Oncology, Medstar Washington Hospital Center, Washington, DC USA.
authors: Pamela
authors: P
authors: Randolph-Jackson
authors: Department of Radiation Oncology, Medstar Washington Hospital Center, Washington, DC USA.
authors: Adedamola
authors: A
authors: Omogbehin
authors: Department of Neurosurgery, Medstar Washington Hospital Center, Washington, DC USA.
authors: Edward F
authors: EF
authors: Aulisi
authors: Department of Neurosurgery, Medstar Washington Hospital Center, Washington, DC USA.
authors: Jeff
authors: J
authors: Jacobson
keywords: Gamma Knife; Long term; Radiosurgery; Tic doloreaux; Trigeminal neuralgia