Long-term follow-up of trigeminal neuralgia treatment using a linear accelerator

While most of the studies examining radiosurgery for trigeminal neuralgia have used a Gamma Knife, a linear accelerator can also be utilized for treatment. We report on 20 patients with trigeminal neuralgia who received 23 treatments with a linear accelerator that delivered a maximum dose of 82.3 - 100 Gy. The median patient follow- up was 56.5 months, 70% of patients had received previous surgical treatment and 20% had secondary ( nonessential) trigeminal neuralgia. Eight ( 35%) radiosurgery treatments resulted in complete pain relief; 5 ( 63%) patients with initial pain relief had pain recurrence at a mean time of 21.5 months. Ten ( 43%) patients reported a 50% or more decrease in pain severity but have not achieved a pain- free state. A total of 18 ( 78%) treatments resulted in no pain or a 50% or greater improvement in pain. Five treatments ( 22%) resulted in less than 50% improvement in pain. We conclude that linear accelerator stereotactic radiosurgery is a viable treatment option for trigeminal neuralgia patients, especially for patients who have not had a previous invasive treatment. Copyright (C) 2004 S. Karger AG, Basel.