title: Repeat Radiosurgery for Trigeminal Neuralgia.
abstract: BACKGROUND
  Repeat Gamma Knife radiosurgery (GKRS) is an established option for patients whose pain has recurred after the initial procedure, with reported success rates varying from 68% to 95%. Predictive factors for response to the repeat GKRS are ill-defined.
  
  
  OBJECTIVE
  This cohort study aimed to report the outcomes and factors predictive of success for patients who have undergone repeated GKRS for trigeminal neuralgia at Wake Forest University Baptist Medical Center.
  
  
  METHODS
  Between 1999 and 2013, 152 patients underwent repeat GKRS at Wake Forest, 125 of whom were available for long-term follow-up. A retrospective chart review and telephone interviews were conducted to determine background medical history, dosimetric data, outcomes, and adverse effects of the procedure.
  
  
  RESULTS
  Eighty-four percent of patients achieved at least Barrow Neurological Institute (BNI) IIIb pain relief, with 46% achieving BNI I. The 1-, 3-, and 5-year rates of BNI I pain relief were 63%, 50%, and 37%, respectively. The 1-, 3-, and 5-year rates of BNI IIIb or better pain relief were 74%, 59%, and 46%, respectively. One patient experienced bothersome numbness and 2 patients developed anesthesia dolorosa. The dominant predictive factors for pain relief were facial numbness after the first GKRS and a positive pain response to the first GKRS.
  
  
  CONCLUSIONS
  Repeat GKRS is an effective method of treating recurrent trigeminal neuralgia. Patients who have facial numbness after the first treatment and a positive pain response to the first GKRS are significantly more likely to respond well to the second treatment.
authors.affiliation: *Departments of Neurosurgery and ‡Radiation Oncology, Wake Forest Baptist Medical Center, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
authors.forename: Corbin A
authors.initials: CA
authors.lastname: Helis
authors.forename: John T
authors.initials: JT
authors.lastname: Lucas
authors.forename: J Daniel
authors.initials: JD
authors.lastname: Bourland
authors.forename: Michael D
authors.initials: MD
authors.lastname: Chan
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Tatter
authors.forename: Adrian W
authors.initials: AW
authors.lastname: Laxton
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006987:Hypesthesia / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D059408:Pain Management / Q000379:methods; D016634:Radiosurgery / Q000379:methods*; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*