Successful radiosurgical treatment of trigeminal neuralgia and related facial pain syndromes: The Australian gamma knife experience

Document Type

Article

Department

Neurosurgery

Abstract

Introduction: This retrospective single-institution study evaluated the safety, efficacy and durability of stereotactic radiosurgery (SRS) for trigeminal neuralgia (TN) and related facial pain syndromes-including TN1, TN2, multiple sclerosis (MS) associated-TN and atypical facial pain (AFP).
Methods: We included 192 patients treated with Gamma Knife SRS between 2015 and 2022 at Australia's only publicly funded GK centre. Outcomes included Barrow Neurological Institute (BNI) pain scores, time to response and relapse. Kaplan-Meier and Cox regression analyses were performed.

Results: Median follow-up was 5 years. Treatment response occurred in 88.5%, with a relapse rate of 30%. Faster response was seen with 85 Gy (p = 0.004) and prior SRS (p = 0.02). MS-related TN relapsed earlier than vascular, tumour, idiopathic or stroke-related causes (p = 0.027) and TN1/TN2/AFP (p < 0.0001). On multivariable analysis, prior balloon compression (HR 3.02, 95% CI 1.07-8.51, p = 0.036) and 85 Gy (HR 2.07, 95% CI 1.29-3.33, p = 0.003) were associated with faster response. Patients with vascular TN (HR 0.32, 95% CI 0.13-0.79, p = 0.013), tumour/stroke/idiopathic aetiology (HR 0.36, 95% CI 0.14-0.91, p = 0.031) had utilised prior medication only (HR 0.18, 95% CI 0.06-0.48, p = 0.001) and had undergone prior MVD alone (HR 0.11, 95% CI 0.03-0.5, p = 0.004) were less likely to relapse.
Conclusion: SRS remains a valuable option for refractory facial pain, including redo SRS in select patients.

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Volume. Issue and pagination are not provided by author/publisher.

AKU Student

no

Publication (Name of Journal)

The Journal of Medical Imaging and Radiation Oncology

DOI

10.1111/1754-9485.70062

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