2862 - Outcomes of High-Dose Gamma Knife Radiosurgery for Medically Refractory Trigeminal Neuralgia: A Single-Institution Experience
Presenter(s)
J. Sekar, J. J. Kim, F. Diaz Molina, M. Marrero, A. Goenka, M. Schulder, M. Eisenberg, and M. Ghaly; Northwell, New Hyde Park, NY
Purpose/Objective(s): Gamma Knife stereotactic radiosurgery (GK-SRS) is widely used for medically refractory trigeminal neuralgia (TN). However, patient-centered outcomes remain insufficiently studied in this challenging setting. We report outcomes from a single-institution experience with high-dose GK-SRS, focusing on pain response, patient satisfaction, and sensory toxicity.
Materials/Methods: We retrospectively reviewed 94 patients with medically refractory TN treated from 2016–2025. The mean prescription dose was 86 Gy (75–90 Gy) delivered to the isocenter in a single fraction. Variables included demographics, prior interventions, baseline pain severity, pain response, patient satisfaction, recurrence, salvage procedures, and facial numbness. Pain response, based on the Visual Analog Scale (1–10) and patient satisfaction measured using the EGFP (Excellent, Good, Fair, Poor) scale (1–4), was categorized as complete response (CR), partial response (PR), or no response (NR). Changes in pain scores were analyzed with paired t-tests or Wilcoxon signed-rank tests. Kaplan–Meier analysis estimated freedom from recurrence and salvage procedures.
Results:
Median follow-up was 18 months (range, 1–60 months). The cohort was 60% female; 46% had prior intervention, with severe baseline pain (median 9–10/10). At =3 months (83% evaluable), CR occurred in 42%, PR in 33%, and NR in 25%, with 75% achieving early improvement. Mean pain scores decreased from 9.0 to 3.5 (p < 0.01); 71% reported high satisfaction (EGFP =3). Among the 76 patients (81%) with =6 months of follow-up, 64% maintained pain control without additional intervention. Actuarial freedom from recurrence was 70% at 1 year and 57% at 2 years; freedom from salvage was 80% and 68%, respectively. Overall, 29% required additional procedures. New or worsened facial numbness occurred in 19%, persisting in 10%. No anesthesia dolorosa was observed. A prescription dose of 90 Gy was not associated with an increased rate of facial numbness.Conclusion: High-dose Gamma Knife radiosurgery resulted in meaningful early pain relief with favorable patient-centered outcomes and acceptable sensory toxicity in patients with refractory trigeminal neuralgia. Durable control is achieved in many patients, though recurrence remains common.