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Gamma Knife Radiosurgery for Trigeminal Neuralgia: A review of 59 patients


Juan B Cortina, Julieta M Silva, Gonçalo Fernandes, Begoña Cattoni, Jose Manuel Brás Cuf, GammaKnife, Lisbon, Portugal


Clinical: CNS


GammaKnife, trigeminal, neuralgia.


Several potentially successful surgical modalities are available to patients with medically refractory Trigeminal Neuralgia (TN). Gamma Knife (GK) is an established therapeutic option for patients with TN. A handful of studied have shown the efficacy of GK but de follow-up has been short. We report a retrospective review of 59 patients with a median follow-up of 60 months.


A retrospective review was conducted for 59 patients who underwent GK for refractory TN at our institution between 2010 and 2023. TN received GK with a mean marginal radiation dose of 42,5 Gy applied to an average isodose line of 50% of the affected trigeminal nerve. Follow-up data were obtained by clinical examination and telephone questionnaire. Outcomes results were evaluated using the Barrow Neurological Institute (BNI) Pain Scale. BNI I-III was considered to be a good outcome and BNI IV-V considered a treatment failure.


The median follow-up was 60 months. Of the total 59 patients, 30 (50,8%) had good outcomes, reported as pain relief within 1 month following de GK treatment. A total of 8 patients (13,6%) experienced complete pain relief off medications (BIN I). At median followup of 60 months, the actuarial rate of freedom from severe pain (BIN>=III) was 27,1%. 21 patients were subjected to a previous surgical treatment. 14 patients were taking more than 3 drugs. 5 patients developed new or increased facial paresthesias after radiosurgery (12,2%).


GK radiosurgery is a minimally invasive technique to treat TN, safe and effective. It is associated with a low risk of facial paresthesias and approximately half patients experienced pain relief

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