To evaluate the role of Gamma Knife radiosurgery as the first surgical
therapy in the management of medically refractory
trigeminal neuralgia, we reviewed outcomes on our first 23 patients who had radiosurgery as primary surgical
therapy. These patients represented 19% of our overall series. Mean patient age was 66 years, and mean follow-up after radiosurgery was 12 months (range 5-33 months). For most patients, radiosurgery was performed because the patient had
medical contraindications to open surgery. 14 patients had 70-Gy radiosurgery, and 9 patients, 80 Gy. Radiosurgery was performed using a single 4 mm isocenter. Postoperative imaging 6 to 9 months following radiosurgery confirmed regions of enhancement at the radiosurgical target. Nine patients received 70 Gy, and 8 patients had 80 Gy. 17 patients (74%) had an excellent result (total
pain relief). Five patients (22%) achieved a good result (50-90% improvement). One patient had a poor result (4%) after 70-Gy radiosurgery and subsequently underwent
microvascular decompression. No patient developed facial
numbness or any other complication after Gamma Knife radiosurgery. Gamma Knife radiosurgery using 70 or 80 Gy targeted to the proximal trigeminal nerve proved to be a safe and effective primary surgical
therapy for medically refractory
trigeminal neuralgia. The overall response rate (96%) was similar to that obtained with other surgical
therapies performed as a first procedure.