Repeat Gamma Knife Radiosurgery for Trigeminal Neuralgia: A Single Institutional Experience

Purpose: Gamma Knife radiosurgery (GK-SRS) for trigeminal neuralgia is an efficacious therapy, with durable pain control rates up to 80%. Some patients may experience return of their pain, prompting re-treatment. Here we review our experience with repeat Gamma Knife radiosurgery for trigeminal neuralgia.

Methods: We queried our institutional database for patients who underwent repeat Gamma Knife radiosurgery for trigeminal neuralgia. Date and time of each course of radiosurgery a patient received were recorded, and their outcomes reviewed. We determined Barrow Neurological Institute (BNI) pain scores pre- and post-repeat radiosurgery for each patient, prescription dose, as well as the Visual Analog Scale (VAS) ratings, and the distribution of pain (V1/V2/V3). Logistic analysis of posttreatment BNI pain scores and VAS were performed, analyzing factors associated with response. A subset analysis was performed to determine if there are any factors associated with a posttreatment BNI score of III-a (no pain while on continued medication) versus III-b (persistent pain, controlled with medications).

Results: Twenty-four patients were identified who underwent repeat GK-SRS from 2015 to 2023. Mean prescribed dose was 75 Gy. The median age of patients was 70, and 62% of patients were female. All patients at presentation, had a BNI score of at least III-b, necessitating medication, with some continued breakthrough pain. 80% of patients had decrease in pain per BNI scale, to III-a (no pain with medication). Post GK-SRS, median decrease in VAS score was 8/10. On our logistic analysis, we did not find any factors, such as dose at first treatment (p = 0.07), re-treatment dose (p = 0.52), total dose (p = 0.82), age at re-treatment (p = 0.95) or gender (p = 0.57) to be significantly associated with BNI score after repeat radiosurgery.

Conclusion: Trigeminal neuralgia is a debilitating condition. Gamma Knife radiosurgery is not only an effective first line therapy, but as our institutional experience demonstrates, it is an effective salvage therapy option. On our logistic analysis, we did not find any factors to be associated with the noted reduction in BNI scale score.

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Artikel online veröffentlicht:
05. Februar 2024