Safety and Efficacy of Gamma Knife Radiosurgery for the Management of Trigeminal Neuralgia: A Retrospective and Cross-Sectional Study.

Abstract

Medical management is the first line of care for patients with trigeminal neuralgia (TN), and carbamazepine is the drug of choice used alone or in combination with other drugs. Gamma knife radiosurgery (GKRS) has been an established option in the management of refractory TN based on its noninvasiveness and robust safety profile. Our study aims to confirm the safety and assess the efficacy of GKRS in the management of TN. A retrospective review of the patients with refractory TN treated with GKRS from 1997 to March 2019 by the senior author was carried out. Out of 194 eligible patients, detailed clinical information was not available in 41 patients. The remaining 153 patients' case files (post-GKRS cohort) were reviewed, and data obtained were collated, computed, and analyzed. An additional cross-sectional analysis was carried out telephonically in the post-GKRS cohort in January 2021 using Barrow Neurological Institute (BNI) pain scoring, to obtain the long-term efficacy of GKRS in TN. The majority of the patients (96.1%) received a radiation dose of 80 Gy. At 6 months, 94.8% of patients had satisfactory response to GKRS. Follow-up ranged between 1 and 7.5 years. The recurrence rate was 9.2% and the complication rate was 4.6%. Facial numbness was the commonest complication. No mortality was reported. The cross-sectional arm of the study had a response rate of 39.2% (60 patients). Adequate pain relief (BNI I/II/IIIa/IIIb) was reported in 85% of patients. GKRS is a safe and effective modality of treatment for TN without any major complications. Both short-term and long-term efficacies are excellent.