Sterotactic Radiosurgery for Trigeminal Neuralgia: Single Center Experience

Objective: We evaluated our results with stereotactic radiosurgery in trigeminal neuralgia (TN). Methods: Thirteen patients diagnosed with TN resistant to medical treatments applied for SRS with Cyberknife (Accuray, Sunnyvale, CA) between 2013 and 2018 were evaluated retrospectively. Treatment planning CT with 1 mm slice thickness was fused with contrast-enhanced T1 axial and T2 flair cranial MRI images with 1.25 mm slice thickness. As a targeted region the area extending from the point where trigeminal nerve leaves the pons up to its entrance into the Meckel cave (retrogasserian zone) was contoured. All patients received 60 Gy SRC with a median reference dose of 80% (68%-87%). Results: After a median follow-up of 12 (3-72) months, complete response was achieved in 10 patients (76.9%). Median time to response was 45 (1-180) days. Response was achieved during the first month after treatment in 5 (50%) patients. Three patients refractory to treatment did not have a history of operation and 2 of them had atypical (steady) pain. During follow-up, 2 of 9 patients (22.2%) who did not have hypoesthesia before treatment had BNI class II-III hypoesthesia. Four patients (30.8%) quit taking pills after stereotactic radiosurgery. Conclusion: SRC for TN resistant to medical treatment is a successful treatment for pain palliation.