Clinical outcomes after stereotactic radiosurgery for idiopathic trigeminal neuralgia

Object. Stereotactic radiosurgery is an increasingly used and the least inv asive surgical option for patients with trigeminal neuralgia. In this study , the authors investigate the clinical outcomes in patients treated with th is procedure. Methods. Independently acquired data from 220 patients with idiopathic trig eminal neuralgia who underwent gamma knife radiosurgery were reviewed. The median age was 70 years (range 26-92 years). Most patients had typical feat ures of trigeminal neuralgia, although 16 (7.3%) described additional atypi cal features. One hundred thirty-five patients (61.4%) had previously under gone surgery and 80 (36.4%) had some degree of sensory disturbance related to the ear lier surgery. Patients were followed for a maximum of 6.5 years (median 2 years). Complet e or partial relief was achieved in 85.6% of patients at 1 year. Complete p ain relief was achieved in 64.9% of patients at 6 months, 70.3% at 1 year, and 75.4% at 33 months. Patients with an atypical pain component had a lowe r rate of pain relief (p = 0.025). Because of recurrences, only 55.8% of pa tients had complete or partial pain relief at 5 years. The absence of preop erative sensory disturbance (p = 0.02) or previous surgery (p = 0.01) corre lated with an increased proportion of patients who experienced complete or partial pain relief over lime. Thirty patients (13.6%) reported pain recurr ence 2 to 58 months after initial relief (median 15.4 months). Only 17 pati ents (10.2% at 2 years) developed new or increased subjective facial parest hesia or numbness, including one who developed deaPferentation pain. Conclusions. Radiosurgery for idiopathic trigeminal neuralgia was safe and effective, and it provided benefit to st patient population with a high fre quency of prior surgical intervention.