Outcome for patients with essential trigeminal neuralgia treated with linear accelerator stereotactic radiosurgery.

Background: Stereotactic radiosurgery (SRS) is one option for treatment of trigeminal neuralgia, after unsuccessful conservative approaches.

Objectives: The objective of this study was to retrospectively evaluate our institutional results in the management of patients with idiopathic trigeminal neuralgia treated with linear accelerator SRS.

Methods: Fifty-two patients were treated between January 1998 and December 2009 and were followed for more than 6 months (median: 26.6 months). Forty-seven patients (90%) had undergone previous surgery before SRS. The target dose ranged from 50 to 80 Gy.

Results: After SRS, 9 patients presented complete remission of the pain, and 21 were pain free but still under medication. Eleven patients reported a relief of more than 50% in crisis frequency. In 9 patients, no significant improvements were seen, and 2 presented an exacerbation of the pain. After an average period of 20 months, 15 patients reported pain recurrence. Results were better in patients older than 60 years (p = 0.019). Nineteen patients presented facial numbness after SRS, with a trend toward favorable treatment response (p = 0.06).

Conclusion: SRS is an effective alternative to the treatment of essential trigeminal neuralgia, with long-lasting pain relief in more than 50% of the patients. Better results were seen with patients aged more than 60 years.