Review Article

Clinical Outcomes of Gamma Knife Radiosurgery in the Treatment of Patients with Trigeminal Neuralgia

Table 1

Clinical outcomes of patients undergoing a single Gamma Knife treatment.

Author (year)Clinical evaluation methodGKRS max dose (Gy)Study endpointsResults

Patients with vessel impingement59%
Pain relief in patients with or w/o vascular impingementP = NS
BNI score I57%
Sheehan et al. [9] (2010)BNIMedian: 84BNI score II17%
BNI score III13%
BNI score IV10%
BNI score V2%

BNI score I43%
Chen et al. [13] (2010)BNI90BNI score I–IIIb91%
Patients with hypoesthesia11%

BNI score I32.1%
BNI score II3.8%
Riesenburger et al. [10] (2010)BNIMedian: 80BNI score IIIa1.9%
BNI score IIIb20.8%
BNI score IV41.5%
Patients with facial numbness36%

1-y BNI score I–IIIb80%
3-y BNI score I–IIIb71%
Kondziolka et al. [5] (2010)BNI60–905-y BNI score I–IIIb46%
10-y BNI score I–IIIb30%
Patients with facial numbness or paresthesia10.5%

BNI score I22%
Dhople et al. [18] (2007)BNIMedian: 75BNI score II6%
BNI score III44%
Patients with trigeminal dysfunction19%

BNI score I–IIIb76.7%
Han et al. [11] (2009)BNIMean: 79.7Patients with pain recurrence52.2%
Patients with radiation-induced cranial neuropathy15%

1-y actuarial rate of freedom from treatment failure60%
3-y actuarial rate of freedom from treatment failure41%
Dhople et al. [17] (2009)BNIMedian: 755-y actuarial rate of freedom from treatment failure34%
7-y actuarial rate of freedom from treatment failure22%
Superior response duration in patients w/o prior surgery
Patients with facial numbness6%

BNI score I-IIIb82%
Matsuda et al. [16] (2010)BNI80–90Patients with trigeminal nerve dysfunction41.3%

7-y GKRS initial treatment pain-free rate45%
Little et al. [15] (2008)BNI70–907-y GKRS secondary treatment pain-free rate10%
Patients with bothersome facial numbness5%

1-y complete pain relief rate83.1%
2-y complete pain relief rate70.9%
Dellaretti et al. [4] (2008)BNIMean: 85.13-y complete pain relief rate62.5%
Superior pain relief in patients w/o prior surgery
Patients with trigeminal dysfunction21%

BNI score I17.6%
BNI score II17.6%
Park and Hwang [12] (2011)BNI80–90BNI score IIIa41.2%
BNI score IIIb17.6%
BNI score V5.9%
Patients with trigeminal nerve dysfunction23.5%

BNI score I5.7%
Pan et al. [19] (2010)BNI80Patients with pain recurrence44.2%
Patients with facial numbness9.6%

1-y BNI score I26%
Kano et al. [14] (2010)BNI60–901-y BNI score 1-IIIb85%
Patients with trigeminal sensory loss or paresthesia9.3%

Excellent outcome40%
Good outcome10%
Azar et al. [21] (2009)EGFP90Fair outcome33%
Poor outcome17%
Patients with facial numbness13%

Excellent outcome54%
Good outcome4%
Sekula et al.* [20] (2010)EGFPNRFair outcome7%
Poor outcome36%
Patients with facial numbness21%
Patients with dysesthesias11%

Patients with complete pain relief83%
Régis et al. [22] (2006)Median: 85Patients with facial numbness6%
Patients with hypesthesia4%

Patients with complete pain relief32.6%
Knafo et al. [23] (2009)80Patients with significant pain relief77.6%
Patients with sensory side effects14.9%

Patients pain-free w/o medication61%
Longhi et al. [24] (2007)      75–95Patients pain-free with medication29%
Patients with no pain relief10%
Patients with side effects9%

Patients with complete pain relief29.9%
Kang et al. [25] (2008)Mean: 84.3Patients with pain improvement49.4%
Patients with side effects15.6%

BNI: Barrow Neurological Institute; EGFP: excellent-good-fair-poor; GKRS: Gamma Knife radiosurgery; MVD: microvascular decompression; NR: not reported; NS: nonsignificant.
*Study includes patients treated with MVD after failed GKRS.