Outcome of Patients Undergoing Gamma Knife Stereotactic Radiosurgery for Medically Refractory Idiopathic Trigeminal Neuralgia: Medical College of Georgia’s Experience

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Abstract
Gamma knife radiosurgery represents an established treatment option for the management of medically refractory trigeminal neuralgia (TN). In our current communication we present our experience in radiosurgically treating patients with idiopathic TN. Over a period of 5 years, 77 patients underwent gamma knife radiosurgery. The patients were divided into 2 groups based on their previous surgical treatment. In the group of patients with no previous surgeries, the initial response rate was 92.4% (48/52 patients), while in the group with previous surgeries it was 84% (21/25 patients). The excellent outcome rates (complete pain relief with no pain medications) at the completion of 1, 2 and 3 years after treatment for the group with no previous surgeries were: 80.8% (42/52 patients), 69.2% (36/52 patients) and 53.8% (28/52 patients), respectively. The respective excellent outcome rates for the group of patients with previous surgeries were: 64% (16/25 patients), 44% (11/25 patients) and 12% (3/25 patients). The good outcome rates at the completion of 1, 2 and 3 years after treatment for the group with no previous surgeries were: 7.7% (4/52 patients), 11.5% (6/52 patients) and 19.2% (10/52 patients). The respective percentages of good outcome for the patients with previous surgery were: 12% (3/25 patients) at 1 year, 16% (4/25 patients) at 2 years and 32% (8/25 patients) at the completion of 3 years after treatment. The most commonly encountered complication in our series was the development of facial numbness. Our findings confirm previous reports that the presence of preceding surgical interventions represents a negative long-term outcome factor. However, gamma knife radiosurgery constitutes a safe and efficient minimally invasive treatment option for patients with idiopathic TN.