Outcome of radiosurgery treatment with a linear accelerator in patients with trigeminal neuralgia

Introduction: An overview of the effectiveness of radiosurgery in patients diagnosed with trigeminal neuralgia with an analysis of potential predictors of good outcome. Methods: All patients treated with linear accelerator radiosurgery between 2004 and 2011 were analysed. A dose of 60 Gy dose was administered 1 to 2 mm from the root entry zone with a maximum isodose of 20% delivered to the brainstem. Clinical results for pain control and any " side effects were analysed at 12 and 36 months (BNI score). Results: The study included 71 patients (mean follow-up 50.5 months). Pain improvement at 12 months was observed in 68.11% of the total (28.98% with BNI score Hi; 39.12% with BNI score III) and at 36 months in 58.21% (23.88% BNI score I-II; 34.32% BNI score III). Average recovery time was 3.69 months and the relapse rate was 44.68%. Patients with typical pain displayed statistically significant differences in improvement rates at 12 and at 36 months (P<047 and P<.002). Onset of improvement was analysed using Kaplan-Meyer plots. Statistically significant differences were observed between patients with typical and atypical pain at 36 months (P<.012) in Kaplan-Meyer plots. Side effects were recorded in 15 patients (20.89%), including 9 cases of facial numbness (13.43%); only 2 cases were clinically relevant (2.98%). Conclusion: According to our results, radiosurgery is an effective treatment for trigeminal neuralgia, with few side effects. Typical pain seems to be a good predictor of pain relief. (C) 2015 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L.U.