Gamma Knife surgery used as primary and repeated treatment for idiopathic trigeminal neuralgia

2008 ◽  
Vol 109 (Supplement) ◽  
pp. 179-184 ◽  
Author(s):  
Chuan-Fu Huang ◽  
Hsien-Tang Tu ◽  
Wen-Shan Liu ◽  
Shyh-Ying Chiou ◽  
Long-Yau Lin
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
Repeated Treatment ◽  
Maximal Dose ◽  
Idiopathic Trigeminal Neuralgia ◽  
Facial Numbness ◽  
The Mean

Object The purpose of this study was to assess the outcome of idiopathic trigeminal neuralgia (TN) treated with Gamma Knife surgery (GKS) as a primary and repeated treatment modality with a mean follow-up of 5.7 years. Methods Between July 1999 and September 2005, a total of 89 patients with idiopathic TN underwent GKS as a primary treatment. The entry zone of the TN was targeted with a 4-mm collimator and treated with a maximal dose of 60–90 Gy (mean 79 Gy). The dose to the pontine margin was always kept < 15 Gy. Twenty patients received repeated GKS for recurrent or residual pain with a maximal dose of 40–76 Gy (mean 52 Gy). For the second procedure, the target was positioned at the same location as the first treatment. Results The mean follow-up period was 68 months (range 32–104 months). Sixty-nine (77.5%) of the 89 patients experienced a favorable response, as follows: 50 (56%) had excellent, 12 (13.5%) had good, and 7 (7.8%) had fair outcomes. The mean time to pain relief was 1.1 months (range 2 days–6 months). No significant correlation, but more likely a tendency, was found between the dose and pain relief (p = 0.08). Also, no correlation was noted for facial numbness (p = 0.77). The mean follow-up period after repeated GKS was 60 months (range 32–87 months). Outcomes after repeated GKS were excellent in 11 patients (55%) and good in 1 (5%). Seven patients experienced facial numbness. No correlation was found between the additive dose and pain relief (p = 0.24) or facial numbness (p = 0.15). Final outcomes of primary and repeated GKS were excellent in 61 (68.5%), good in 13 (14.6%), and fair in 7 (7.9%). In total, 91% of the patients were successfully treated with this method. There was no statistical significance for efficacy between primary and repeated GKS (p = 0.65), but there was a significant difference for facial numbness (p = 0.007). Conclusions Gamma Knife surgery established durable pain relief when used as a primary and repeated surgery. Treatment was successful for a total of 91% of patients at a mean follow-up of 5.7 years, but facial numbness was also relatively higher.

Clinical outcomes after Gamma Knife surgery for idiopathic trigeminal neuralgia: review of 76 consecutive cases

2008 ◽  
Vol 109 (Supplement) ◽  
pp. 173-178 ◽  
Author(s):  
Marcos Dellaretti ◽  
Nicolas Reyns ◽  
Gustavo Touzet ◽  
Thierry Sarrazin ◽  
François Dubois ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
Retrospective Evaluation ◽  
Previous Surgery ◽  
Idiopathic Trigeminal Neuralgia ◽  
Facial Numbness ◽  
The Mean ◽  
Low Rate

Object Stereotactic radiosurgery is an increasingly used, and the least invasive, surgical option for patients with trigeminal neuralgia (TN). In this study, the authors performed a retrospective evaluation of the safety and efficacy of this method for idiopathic TN. Methods The authors reviewed data from 76 patients with idiopathic TN who underwent Gamma Knife surgery (GKS). The mean age of the patients was 64 years (range 27–83 years). All patients had typical features of TN. Thirty patients (39.5%) had previously undergone surgery. The intervention consisted of GKS on the retrogasserian cisternal portion of the fifth cranial nerve. The mean maximum GKS dose used was 85.1 Gy (range 75–90 Gy). Results Patients were followed-up from 6 to 42 months (mean 20.3 months) after GKS. Complete pain relief was achieved in 83.1% of the patients within 1 year, 70.9% within 2 years, and 62.5% within 3 years. Patients who underwent previous surgery demonstrated a lower rate of pain relief (p < 0.05). Twenty patients (26.3%) reported pain recurrence between 6 and 42 months after treatment. New or worsened persistent trigeminal dysfunction developed after GKS in 16 patients (21%); 8 of these patients described some facial numbness/not bothersome, and 8 reported some facial numbness/somewhat bothersome. None of the patients developed troublesome dysesthesia or anesthesia dolorosa. Conclusions Gamma Knife surgery for idiopathic TN proved to be safe and effective and was associated with a particularly low rate of complications.

CYBERKNIFE RADIOSURGERY FOR TRIGEMINAL NEURALGIA TREATMENT

Neurosurgery ◽  
2008 ◽  
Vol 62 (3) ◽  
pp. 647-655 ◽  
Author(s):  
Alan T. Villavicencio ◽  
Michael Lim ◽  
Sigita Burneikiene ◽  
Pantaleo Romanelli ◽  
John R. Adler ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Radiation Doses ◽  
Maximal Dose ◽  
Median Length ◽  
Pain Medications ◽  
Idiopathic Trigeminal Neuralgia ◽  
Cyberknife Radiosurgery ◽  
The Mean

Abstract OBJECTIVE Radiosurgery has gained acceptance as a treatment option for trigeminal neuralgia. We report our preliminary multicenter experience treating trigeminal neuralgia with the CyberKnife (Accuray, Inc., Sunnyvale, CA). METHODS A total of 95 patients were treated for idiopathic trigeminal neuralgia between May 2002 and October 2005. Radiosurgical dose and volume parameters were retrospectively analyzed in relation to pain response, complications, and recurrence of symptoms. Optimal treatment parameters were identified for patients who had excellent and sustained pain relief with no complications, including severe or moderate hypesthesia. RESULTS Excellent pain relief was initially experienced by 64 out of 95 patients (67%). The median time to pain relief was 14 days (range, 0.3–180 d). Posttreatment numbness occurred in 45 (47%) of the patients treated. Using higher radiation doses and treating longer segments of the nerve led to both better pain relief and a higher incidence of hypesthesia. The presence of posttreatment numbness was predictive of better pain relief. The overall rate of complications was 18%. At the mean follow-up time of 2 years, 47 of the 95 patients (50%) had sustained pain relief, all of whom were completely off pain medications. CONCLUSION The results of this study suggest the following optimal radiosurgical treatment parameters for treatment of idiopathic trigeminal neuralgia: a median maximal dose of 78 Gy (range, 70–85.4 Gy) and a median length of the nerve treated of 6 mm (range, 5–12 mm).

Gamma Knife surgery for recurrent or residual trigeminal neuralgia after a failed initial procedure

2010 ◽  
Vol 113 (Special_Supplement) ◽  
pp. 172-177 ◽  
Author(s):  
Chuan-Fu Huang ◽  
Shyh-Ying Chiou ◽  
Ming-Fang Wu ◽  
Hsien-Tang Tu ◽  
Wen-Shan Liu
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Pain Control ◽  
Initial Treatment ◽  
Gamma Knife Surgery ◽  
Significant Difference ◽  
Facial Numbness ◽  
Initial Procedure

Object The purpose of this study was to assess outcomes of Gamma Knife surgery (GKS) as a second treatment for recurrent or residual trigeminal neuralgia (TN) after failure of 3 initial procedures: microvascular decompression (MVD), GKS, and percutaneous radiofrequency rhizotomy (PRR). Methods Between 1999 and 2008, 65 patients (31 men [48%] and 34 women [52%]) with recurrent TN were treated with GKS. All 65 patients had undergone previous medical procedures that failed to achieve sufficient pain relief: 27 patients (42%) had undergone MVD, 8 (12%) had undergone PRR, and 30 (46%) had undergone GKS as the initial treatment. The entry zone of the trigeminal nerve was targeted using a 4-mm collimator and treated with 35–90 Gy. The isocenter was positioned so that the brainstem surface was usually irradiated at an isodose no greater than 20% (59 patients) to 30% (6 patients). The median duration of TN symptoms in these patients was 39 months (range 1–192 months). Results At the clinical evaluation, 42 patients (65%) with idiopathic TN reported successful pain control at a median follow-up point of 64 months (range 18–132 months). Of these patients, 33 (51%) were no longer using medication. At the 1-, 2-, and 3-year follow-up examinations, 74%, 71%, and 66% of patients experienced successful pain control, respectively. There was no significant difference in pain relief in the initial MVD group compared with the initial GKS and initial PRR groups (74% vs 59% and 50%, respectively; p = 0.342). Recurrence of pain was noted in 23 patients. Twelve of these 23 patients underwent another GKS, resulting in pain control in 8 patients (67%); 8 other patients underwent MVD, resulting in pain relief in 7 patients (87.5%). The median time from GKS to pain recurrence was 7 months (range 3–48 months). There was no significant difference in new facial numbness among the 3 groups (p = 0.24); however, in the initial GKS group, facial numbness was significantly associated with freedom from pain (p = 0.0012). There was a significant correlation between the total radiation dose and facial numbness. The cutoff value for facial numbness ranged from 115 to 120 Gy (p = 0.037). Conclusions Gamma Knife surgery as a second treatment achieved acceptable levels of pain control in 65% of patients with residual or recurrent TN after long-term follow-up. Initial treatment was not a factor that affected pain control, but salvage surgery may be considered separately for each group.

Gamma Knife surgery for trigeminal pain caused by benign brain tumors

2008 ◽  
Vol 109 (Supplement) ◽  
pp. 154-159 ◽  
Author(s):  
Chuan-Fu Huang ◽  
Hsien-Tang Tu ◽  
Wen-Shan Liu ◽  
Long-Yau Lin
Keyword(s):  
Pain Relief ◽  
Tumor Growth ◽  
Gamma Knife ◽  
Benign Tumor ◽  
Gamma Knife Surgery ◽  
Trigeminal Pain ◽  
Facial Numbness ◽  
The Mean ◽  
Mean Time

Object The authors report the effects of Gamma Knife surgery (GKS) on benign tumor–related trigeminal pain in patients who underwent follow-up for a mean 57.8 months. Methods From 1999 to 2004, 21 patients with benign tumor–related trigeminal pain (12 meningiomas and 9 schwannomas) underwent GKS as a primary or repeated treatment. These patients harbored tumors within the radiosurgical target area. For meningiomas, the mean radiosurgical treatment volume was 8.2 ml (range 1.1–21 ml), and the mean radiosurgical tumor margin dose was 12.7 Gy (range 12–15 Gy); for schwannomas, the mean volume was 5.6 ml (range 2–9.2 ml), and the mean marginal dose was 13 Gy (range 11.5–16 Gy). Seven patients underwent retreatment for recurrent or persistent pain; the ipsilateral trigeminal nerve or ganglion was identified and a mean maximal dose of 60.7 Gy (range 40–70 Gy) was delivered to these targets. In 1 patient undergoing retreatment, the margin dose was 12 Gy. The mean age at the time of radiosurgery was 54.5 years (range 18–79 years). Results The mean follow-up period was 57.8 months (range 36–94 months). Overall, 12 (57%) of 21 patients experienced pain relief without medication after the first GKS and the mean time to drug discontinuation was 10.5 months (range 2–24 months). Initial pain improvement was noted in 17 patients (81%) with a mean time of 3.7 months (range 1 week–10 months) after GKS. Eight patients underwent repeated GKS for persistent and recurrent pain. Four patients (50%) had complete pain relief. The final results of the first and repeated GKS were excellent in 16 patients (76%), and in only 1 patient did GKS fail, and this patient later underwent open surgery. For all 21 patients (100%), control of tumor growth was documented at a mean of 46 months after GKS. Three of 6 patients with pre-GKS facial numbness reported improvement, but 4 suffered new facial numbness after repeated GKS. Conclusions Gamma Knife surgery appears to be an effective tool to treat benign tumor–related trigeminal pain and control tumor growth. Repeated GKS targeting the trigeminal root or ganglion can be considered a tool to enhance the efficacy of pain management if pain persists or recurs, but the optimum treatment dose needs further investigation.

Repeated Gamma Knife surgery for refractory trigeminal neuralgia

2006 ◽  
Vol 105 (Supplement) ◽  
pp. 99-102 ◽  
Author(s):  
Chuan-Fu Huang ◽  
Jim-Chao Chuang ◽  
Hsien-Tang Tu ◽  
Long-Yau Lin
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Prospective Trial ◽  
Late Complications ◽  
Gamma Knife Surgery ◽  
Dose Effect ◽  
Duration Of Symptoms ◽  
Facial Numbness

ObjectRepeated Gamma Knife surgery (GKS) for trigeminal neuralgia (TN) is an acceptable method for refractory cases but not well established in terms of dose effect and nerve tolerance. The authors report their experience in 28 patients over 3.5 years of follow up.MethodsBetween 1999 and 2004, a total of 28 patients with recurrent or residual TN underwent repeated GKS. The median follow-up periods were 52 and 43 months after the first and repeated procedures, respectively. The entry zone of the trigeminal nerve was targeted using a 4-mm collimator and treated with 40 to 76 Gy as maximal dose. Additive doses ranged between 110 and 152 Gy. The median duration of symptoms was 4.86 years. There were 12 women (46%) and 16 men (54%).At the last evaluation, a total of 19 patients (68%) reported pain relief. Of these patients, 13 were no longer taking pain medications. Significant recurrent or residual pain was noted in nine patients after a median follow up of 12 months (range 6–48 months). New onset of facial numbness was noted in 10 patients. An additive dose above 115 Gy was found to be associated with facial numbness and nonfacial numbness (p = 0.047). No definite additive dose correlation with pain relief was noted (p = 0.23).Conclusions Repeated GKS established durable pain relief in a majority of patients, and a higher additive dose (> 115 Gy) tended to cause facial numbness. However, a prospective trial is needed to fully assess the efficacy and late complications of GKS.

Stereotactic gamma knife surgery for trigeminal neuralgia: detailed analysis of treatment response

2005 ◽  
Vol 102 (3) ◽  
pp. 442-449 ◽  
Author(s):  
Rabih G. Tawk ◽  
Mary Duffy-Fronckowiak ◽  
Bryan E. Scott ◽  
Ronald A. Alberico ◽  
Aidnag Z. Diaz ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Treatment Response ◽  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
Limiting Factors ◽  
Content Type ◽  
Facial Numbness ◽  
Fine Print

Object. The purpose of this study was to assess the durability and completeness of pain relief in patients treated using stereotactic gamma knife surgery (GKS) for trigeminal neuralgia (TN). Methods. Thirty-eight patients with refractory TN were treated with stereotactic GKS. All patients received a prescription radiation dose of 35, 40, or 45 Gy to the 50% isodose surface through a 4-mm collimator helmet. The group was assessed regularly based on physician-directed interviews for a median follow up of 24 months (range 6–27 months). Pain relief was classified as excellent (no pain without medication), good (well-controlled pain with continued medication), fair (decreased but residual pain with continued medication), or poor (unimproved or increased pain with the same or increased medication). Three months after treatment, pain relief was good or excellent in 71% of patients. By 24 months post-GKS, 50% of the original cohort had poor pain relief, 21% continued to have either excellent or good relief, 3% had fair relief, and 26% had not reached the 24-month follow up. Based on their status at the last follow up, 29% of patients had excellent and 16% had good pain relief. Thirty-seven percent experienced facial numbness, which was dose related. In addition, there was a significantly higher rate of complete pain relief in patients who had facial numbness following treatment (p = 0.003). Conclusions. Stereotactic GKS is an effective treatment in patients with TN; however, the durability of pain relief and the time to treatment response are limiting factors. As with other types of ablative treatment, facial numbness is strongly associated with better treatment response.

Long-term Follow-up of Patients Treated with Percutaneous Radiofrequency Thermocoagulation via the Foramen Rotundum for Isolated Maxillary Nerve Idiopathic Trigeminal Neuralgia

Pain Medicine ◽  
2019 ◽  
Vol 20 (7) ◽  
pp. 1370-1378 ◽  
Author(s):  
Bing Ran ◽  
Jun Wei ◽  
Qiong Zhong ◽  
Min Fu ◽  
Jun Yang ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Sagittal Plane ◽  
Ct Guided ◽  
Radiofrequency Thermocoagulation ◽  
Complete Pain Relief ◽  
Idiopathic Trigeminal Neuralgia ◽  
Foramen Rotundum ◽  
The Mean

Abstract Objective The purpose of this study is to evaluate the effectiveness and safety of percutaneous radiofrequency thermocoagulation (PRT) via the foramen rotundum (FR) for the treatment of isolated maxillary (V2) idiopathic trigeminal neuralgia (ITN) and assess the appropriate puncture angle through the anterior coronoid process to reach the FR. Methods Between January 2011 and October 2016, 87 patients with V2 ITN refractory to conservative treatment were treated by computed tomography (CT)–guided PRT via the FR at our institution. The outcome of pain relief was assessed by the visual analog scale (VAS) and Barrow Neurological Institute (BNI) pain grade and grouped as complete pain relief (BNI grades I–III) or unsuccessful pain relief (BNI grades IV–V). Recurrence and complications were also monitored and recorded. The puncture angle for this novel approach was assessed based on intraoperative CT images. Results Of the 87 treated patients, 85 (97.7%) achieved complete pain relief, and two patients (2.3%) experienced unsuccessful pain relief immediately after operation. During the mean follow-up period of 44.3 months, 15 patients (17.2%) experienced recurring pain. No severe complications occurred, except for hypoesthesia restricted to the V2 distribution in all patients (100%) and facial hematoma in 10 patients (11.5%). The mean puncture angle to reach the FR was 33.6° ± 5.7° toward the sagittal plane. Discussion CT-guided PRT via the FR for refractory isolated V2 ITN is effective and safe and could be a rational therapy for patients with V2 ITN.

scholarly journals Assessment of pain control, quality of life, and predictors of success after gamma knife surgery for the treatment of trigeminal neuralgia

2005 ◽  
Vol 18 (5) ◽  
pp. 1-7 ◽  
Author(s):  
Ajay Jawahar ◽  
Rishi Wadhwa ◽  
Caglar Berk ◽  
Gloria Caldito ◽  
Allyson Delaune ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Patient Satisfaction ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Pain Control ◽  
Gamma Knife Surgery ◽  
Patient Satisfaction Score

Object There are various surgical treatment alternatives for trigeminal neuralgia (TN), but there is no single scale that can be used uniformly to assess and compare one type of intervention with the others. In this study the objectives were to determine factors associated with pain control, pain-free survival, residual pain, and recurrence after gamma knife surgery (GKS) treatment for TN, and to correlate the patients' self-reported quality of life (QOL) and satisfaction with the aforementioned factors. Methods Between the years 2000 and 2004, the authors treated 81 patients with medically refractory TN by using GKS. Fifty-two patients responded to a questionnaire regarding pain control, activities of daily living, QOL, and patient satisfaction. The median follow-up duration was 16.5 months. Twenty-two patients (42.3%) had complete pain relief, 14 (26.9%) had partial but satisfactory pain relief, and in 16 patients (30.8%) the treatment failed. Seven patients (13.5%) reported a recurrence during the follow-up period, and 25 (48.1%) reported a significant (> 50%) decrease in their pain within the 1st month posttreatment. The mean decrease in the total dose of pain medication was 75%. Patients' self-reported QOL scores improved 90% and the overall patient satisfaction score was 80%. Conclusions The authors found that GKS is a minimally invasive and effective procedure that yields a favorable outcome for patients with recurrent or refractory TN. It may also be offered as a first-line surgical modality for any patients with TN who are unsuited or unwilling to undergo microvascular decompression.

CT-guided selective percutaneous radiofrequency thermocoagulation via the foramen rotundum for isolated maxillary nerve idiopathic trigeminal neuralgia

2018 ◽  
Vol 128 (1) ◽  
pp. 211-214 ◽  
Author(s):  
Quan Wan ◽  
Daying Zhang ◽  
Xintian Cao ◽  
Yong Zhang ◽  
Mengye Zhu ◽  
...  
Keyword(s):  
Pain Relief ◽  
Adverse Effects ◽  
Trigeminal Neuralgia ◽  
Class I ◽  
Ct Guided ◽  
Maxillary Nerve ◽  
Idiopathic Trigeminal Neuralgia ◽  
Foramen Rotundum ◽  
The Mean

OBJECTIVEAlthough CT-guided selective percutaneous radiofrequency thermocoagulation (PRFT) via the foramen rotundum (FR) has been used in the clinic as a novel successful treatment for isolated, second division (maxillary nerve [V2]), idiopathic trigeminal neuralgia (ITN), there is only very limited related literature published to date. This report aims to provide more detail for physicians about this technique.METHODSBetween March 2013 and April 2014, 20 patients with isolated V2 ITN refractory to or intolerant of drug treatment were treated by CT-guided selective PRFT via the FR at the First Affiliated Hospital of Nanchang University. The outcome of pain relief was assessed using the Barrow Neurological Institute (BNI) pain score, and grouped as good (BNI Class I or II, no medication required) and bad (BNI Class III–V, medication required or failed). Recurrence was defined as a relapse to a previous lower level after attainment of any higher level of pain relief. Adverse effects and complications were also monitored and recorded.RESULTSAll patients (100%) obtained good pain relief including BNI Class I in 17 patients (85%) and BNI Class II in 3 patients (15%) immediately postoperatively. None of the patients were lost to follow-up. During the mean follow-up period of 24.3 months (range 18–30 months), 2 patients (10%) experienced recurring pain and the mean time until recurrence was 10.5 months (range 8–13 months). No adverse effects or complications occurred except for transient numbness restricted to the V2 dermatome in all patients (100%) and facial hematoma in 3 patients (15%).CONCLUSIONSIn the current study, CT-guided selective PRFT via the FR not only achieved absolute selective lesioning to V2, but also helped patients attain successful pain relief with few adverse effects. These limited data suggest that CT-guided selective PRFT via the FR appears to be a feasible, safe, effective, and even relatively ideal treatment for isolated V2 ITN, but these findings need confirmation from further studies.

Gamma knife surgery for trigeminal neuralgia: outcomes and prognostic factors

2005 ◽  
Vol 102 (3) ◽  
pp. 434-441 ◽  
Author(s):  
Jason Sheehan ◽  
Hung-Chuan Pan ◽  
Matei Stroila ◽  
Ladislau Steiner
Keyword(s):  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Univariate Analysis ◽  
Gamma Knife Surgery ◽  
Long Term Results ◽  
Surgical Approaches ◽  
Content Type ◽  
Facial Numbness ◽  
Fine Print

Object. Microvascular decompression (MVD) and percutaneous ablation surgery have historically been the treatments of choice for medically refractory trigeminal neuralgia (TN). Gamma knife surgery (GKS) has been used as an alternative, minimally invasive treatment in TN. In the present study, the authors evaluated the long-term results of GKS in the treatment of TN. Methods. From 1996 to 2003, 151 cases of TN were treated with GKS. In this group, radiosurgery was performed once in 136 patients, twice in 14 patients, and three times in one patient. The types of TN were as follows: 122 patients with typical TN, three with atypical TN, four with multiple sclerosis—associated TN, and seven with TN and a history of a cavernous sinus tumor. In each case, the chosen radiosurgical target was located 2 to 4 mm anterior to the entry of the trigeminal nerve into the pons. The maximal radiation doses ranged from 50 to 90 Gy. The median age of the patients was 68 years (range 22–90 years), and the median time from diagnosis to GKS was 72 months (range 1–276 months). The median follow up was 19 months (range 2–96 months). Clinical outcomes and postradiosurgical magnetic resonance (MR) imaging studies were analyzed. Univariate and multivariate analyses were performed to evaluate factors that correlated with a favorable, pain-free outcome. The mean time to relief of pain was 24 days (range 1–180 days). Forty-seven, 45, and 34% of patients were pain free without medication at the 1-, 2-, and 3-year follow ups, respectively. Ninety, 77, and 70% of patients experienced some improvement in pain at the 1-, 2-, and 3-year follow ups, respectively. Thirty-three (27%) of 122 patients with initial improvement subsequently experienced pain recurrence a median of 12 months (range 2–34 months) post-GKS. Among those whose symptoms recurred, 14 patients underwent additional GKS, six MVD, four glycerol injection, and one patient a percutaneous radiofrequency rhizotomy. Twelve patients (9%) suffered the onset of new facial numbness post-GKS. Changes on MR images post-GKS were noted in nine patients (7%). On univariate analysis, right-sided neuralgia (p = 0.0002) and a previous neurectomy (p = 0.04) correlated with a pain-free outcome; on multivariate analysis, both right-sided neuralgia (p = 0.032) and patient age (p = 0.05) were statistically significant. New onset of facial numbness following GKS correlated with undergoing more than one GKS (p = 0.002). Conclusions. At the last follow up, GKS effected pain relief in 44% of patients. Some degree of pain improvement at 3 years post-GKS was noted in 70% of patients with TN. Although less effective than MVD, GKS remains a reasonable treatment option for those unwilling or unable to undergo more invasive surgical approaches and offers a low risk of side effects.

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