{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T16:56:14Z","timestamp":1792515374801,"version":"4.5.0"},"reference-count":40,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2010,4]]},"abstract":"\nObject<\/jats:title>\nTrigeminal neuralgia pain causes severe disability. Stereotactic radiosurgery is the least invasive surgical option for patients with trigeminal neuralgia. Since different medical and surgical options have different rates of pain relief and morbidity, it is important to evaluate longer-term outcomes.<\/jats:p><\/jats:sec>\n\nMethods<\/jats:title>\nThe authors retrospectively reviewed outcomes in 503 medically refractory patients with trigeminal neuralgia who underwent Gamma Knife surgery (GKS). The median patient age was 72 years (range 26\u201395 years). Prior surgery had failed in 205 patients (43%). The GKS typically was performed using MR imaging guidance, a single 4-mm isocenter, and a maximum dose of 80 Gy.<\/jats:p><\/jats:sec>\n\nResults<\/jats:title>\nPatients were evaluated for up to 16 years after GKS; 107 patients had > 5 years of follow-up. Eighty-nine percent of patients achieved initial pain relief that was adequate or better, with or without medications (Barrow Neurological Institute [BNI] Scores I\u2013IIIb). Significant pain relief (BNI Scores I\u2013IIIa) was achieved in 73% at 1 year, 65% at 2 years, and 41% at 5 years. Including Score IIIb (pain adequately controlled with medication), a BNI score of I\u2013IIIb was found in 80% at 1 year, 71% at 3 years, 46% at 5 years, and 30% at 10 years. A faster initial pain response including adequate and some pain relief was seen in patients with trigeminal neuralgia without additional symptoms, patients without prior surgery, and patients with a pain duration of \u2264 3 years. One hundred ninety-three (43%) of 450 patients who achieved initial pain relief reported some recurrent pain 3\u2013144 months after initial relief (median 50 months). Factors associated with earlier pain recurrence that failed to maintain adequate or some pain relief were trigeminal neuralgia with additional symptoms and \u2265 3 prior failed surgical procedures. Fifty-three patients (10.5%) developed new or increased subjective facial paresthesias or numbness and 1 developed deafferentation pain; these symptoms resolved in 17 patients. Those who developed sensory loss had better long-term pain control (78% at 5 years).<\/jats:p><\/jats:sec>\n\nConclusions<\/jats:title>\nGamma Knife surgery proved to be safe and effective in the treatment of medically refractory trigeminal neuralgia and is of value for initial or recurrent pain management. Despite the goal of minimizing sensory loss with this procedure, some sensory loss may improve long-term outcomes. Pain relapse is amenable to additional GKS or another procedure.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2009.7.jns09694","type":"journal-article","created":{"date-parts":[[2009,9,11]],"date-time":"2009-09-11T14:21:45Z","timestamp":1252678905000},"page":"758-765","source":"Crossref","is-referenced-by-count":232,"title":["Gamma Knife stereotactic radiosurgery for idiopathic trigeminal neuralgia"],"prefix":"10.3171","volume":"112","author":[{"given":"Douglas","family":"Kondziolka","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oscar","family":"Zorro","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Lobato-Polo","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideyuki","family":"Kano","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas J.","family":"Flannery","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Flickinger","sequence":"additional","affiliation":[{"name":"Radiation Oncology, and"},{"name":"Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. Dade","family":"Lunsford","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-1120758","series-title":"N Engl J Med","first-page":"1077","article-title":"The long-term outcome of microvascular decompression for trigeminal neuralgia","volume":"334","author":"Barker","year":"1996"},{"issue":"Suppl 3","key":"b2-1120758","series-title":"J Neurosurg","first-page":"159","article-title":"Gamma knife radiosurgery for primary management for trigeminal neuralgia","volume":"93","author":"Brisman","year":"2000"},{"issue":"Suppl 3","key":"b3-1120758","series-title":"J Neurosurg","first-page":"155","article-title":"Gamma knife radiosurgery for trigeminal neuralgia: dose-volume histograms of the brainstem and trigeminal nerve","volume":"93","author":"Brisman","year":"2000"},{"issue":"5 Suppl","key":"b4-1120758","series-title":"Neurosurgery","first-page":"A53","article-title":"Prognostic factors for radiosurgery treatment of trigeminal neuralgia","volume":"62","author":"Chen","year":"2008"},{"key":"b5-1120758","series-title":"Int J Radiat Oncol Biol Phys","first-page":"449","article-title":"Does increased nerve length within the treatment volume improve trigeminal neuralgia radiosurgery? A prospective double-blind, randomized study","volume":"51","author":"Flickinger","year":"2001"},{"key":"b6-1120758","series-title":"Neurosurgery","first-page":"494","article-title":"Repeat radiosurgery for refractory trigeminal neuralgia","volume":"50","author":"Hasegawa","year":"2002"},{"key":"b7-1120758","series-title":"Int J Radiat Oncol Biol Phys","first-page":"82","article-title":"Glycerol rhizotomy versus gamma knife radiosurgery for the treatment of trigeminal neuralgia: an analysis of patients treated at one institution","volume":"63","author":"Henson","year":"2005"},{"key":"b8-1120758","series-title":"Acta Neurochir Suppl","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/978-3-211-78205-7_6","article-title":"Gamma knife radiosurgery for medically refractory idiopathic trigeminal neuralgia","volume":"101","author":"Kang","year":"2008"},{"key":"b9-1120758","series-title":"Neurosurgery","first-page":"524","article-title":"Percutaneous controlled radiofrequency trigeminal rhizotomy for the treatment of idiopathic trigeminal neuralgia: 25-year experience with 1,600 patients","volume":"48","author":"Kanpolat","year":"2001"},{"key":"b10-1120758","series-title":"Clin J Pain","first-page":"42","article-title":"Stereotactic radiosurgery for the treatment of trigeminal neuralgia","volume":"18","author":"Kondziolka","year":"2002"},{"key":"b11-1120758","series-title":"J Neurosurg","first-page":"940","article-title":"Stereotactic radiosurgery for trigeminal neuralgia: a multiinstitutional study using the gamma unit","volume":"84","author":"Kondziolka","year":"1996"},{"key":"b12-1120758","series-title":"Arch Neurol","first-page":"1524","article-title":"Gamma knife radiosurgery for trigeminal neuralgia: results and expectations","volume":"55","author":"Kondziolka","year":"1998"},{"key":"b13-1120758","series-title":"J Neurosurg","first-page":"479","article-title":"Trigeminal neuralgia treated by radiofrequency coagulation","volume":"59","author":"Latchaw","year":"1983"},{"key":"b14-1120758","series-title":"Acta Chir Scand","first-page":"311","article-title":"Sterotaxic radiosurgery in trigeminal neuralgia","volume":"137","author":"Leksell","year":"1971"},{"key":"b15-1120758","series-title":"Stereotact Funct Neurosurg","first-page":"72","article-title":"Functional neurosurgery\u2014a future for the gamma knife?","volume":"57","author":"Lindquist","year":"1991"},{"key":"b16-1120758","series-title":"Neurosurgery","first-page":"915","article-title":"Long-term pain response and quality of life in patients with typical trigeminal neuralgia treated with gamma knife stereotactic radiosurgery","volume":"63","author":"Little","year":"2008"},{"key":"b17-1120758","series-title":"Int J Radiat Oncol Biol Phys","first-page":"522","article-title":"Salvage gamma knife stereotactic radiosurgery for surgically refractory trigeminal neuralgia","volume":"74","author":"Little","year":"2009"},{"key":"b18-1120758","series-title":"Neurosurg Clin N Am","first-page":"11","article-title":"Microvascular decompression for trigeminal neuralgia. Surgical technique and long-term results","volume":"8","author":"Lovely","year":"1997"},{"key":"b19-1120758","series-title":"Clin Neurosurg","first-page":"319","article-title":"Choice of surgical therapeutic modalities for treatment of trigeminal neuralgia: microvascular decompression, percutaneous retrogasserian thermal, or glycerol rhizotomy","volume":"32","author":"Lunsford","year":"1985"},{"key":"b20-1120758","series-title":"J Neurosurg","first-page":"14","article-title":"Clinical outcomes after stereotactic radiosurgery for idiopathic trigeminal neuralgia","volume":"94","author":"Maesawa","year":"2001"},{"key":"b21-1120758","series-title":"Neurosurgery","first-page":"1295","article-title":"Gamma knife radiosurgery for trigeminal neuralgia","volume":"56","author":"McNatt","year":"2005"},{"key":"b22-1120758","series-title":"J Neurosurg","first-page":"140","article-title":"Long-term results of Gasserian ganglion electrocoagulation","volume":"42","author":"Menzel","year":"1975"},{"key":"b23-1120758","series-title":"J Korean Neurosurg Soc","first-page":"199","article-title":"The treatment outcome of elderly patients with idiopathic trigeminal neuralgia: micro-vascular decompression versus gamma knife radiosurgery","volume":"44","author":"Oh","year":"2008"},{"key":"b24-1120758","series-title":"Clin J Pain","first-page":"311","article-title":"Neurosurgery for trigeminal neuralgia: comparison of alcohol block, neurectomy, and radiofrequency coagulation","volume":"12","author":"Oturai","year":"1996"},{"issue":"5","key":"b25-1120758","series-title":"Neurosurg Focus","first-page":"E6","article-title":"Comparison of posterior fossa exploration and stereotactic radiosurgery in patients with previously nonsurgically treated idiopathic trigeminal neuralgia","volume":"18","author":"Pollock","year":"2005"},{"key":"b26-1120758","series-title":"Int J Radiat Oncol Biol Phys","first-page":"192","article-title":"Repeat radiosurgery for idiopathic trigeminal neuralgia","volume":"61","author":"Pollock","year":"2005"},{"issue":"Suppl 3","key":"b27-1120758","series-title":"J Neurosurg","first-page":"162","article-title":"Results of repeated gamma knife radiosurgery for medically unresponsive trigeminal neuralgia","volume":"93","author":"Pollock","year":"2000"},{"key":"b28-1120758","series-title":"Neurosurgery","first-page":"58","article-title":"High-dose trigeminal neuralgia radiosurgery associated with increased risk of trigeminal nerve dysfunction","volume":"49","author":"Pollock","year":"2001"},{"key":"b29-1120758","series-title":"J Neurosurg","first-page":"347","article-title":"Stereotactic radiosurgery for idiopathic trigeminal neuralgia","volume":"97","author":"Pollock","year":"2002"},{"key":"b30-1120758","series-title":"J Neurosurg","first-page":"199","article-title":"Long-term outcome after gamma knife surgery for secondary trigeminal neuralgia","volume":"95","author":"Regis","year":"2001"},{"key":"b31-1120758","series-title":"J Neurosurg","first-page":"913","article-title":"Prospective controlled trial of gamma knife surgery for essential trigeminal neuralgia","volume":"104","author":"Regis","year":"2006"},{"key":"b32-1120758","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1013","article-title":"Gamma knife radiosurgery for trigeminal neuralgia: the initial experience of The Barrow Neurological Institute","volume":"47","author":"Rogers","year":"2000"},{"key":"b33-1120758","series-title":"J Neurosurg","first-page":"434","article-title":"Gamma knife surgery for trigeminal neuralgia: outcomes and prognostic factors","volume":"102","author":"Sheehan","year":"2005"},{"key":"b34-1120758","series-title":"J Neurosurg","first-page":"536","article-title":"Gamma knife radiosurgery for recurrent trigeminal neuralgia","volume":"97","author":"Shetter","year":"2002"},{"key":"b35-1120758","series-title":"Neurosurgery","first-page":"865","article-title":"Comparison of surgical treatments for trigeminal neuralgia: reevaluation of radiofrequency rhizotomy","volume":"38","author":"Taha","year":"1996"},{"key":"b36-1120758","series-title":"Acta Neurochir (Wien)","first-page":"243","article-title":"Various surgical modalities for trigeminal neuralgia: literature study of respective long-term outcomes","volume":"150","author":"Tatli","year":"2008"},{"key":"b37-1120758","series-title":"J Neurosurg","first-page":"757","article-title":"A 10-year experience in the treatment of trigeminal neuralgia. Comparison of percutaneous stereotaxic rhizotomy and posterior fossa exploration","volume":"57","author":"van Loveren","year":"1982"},{"key":"b38-1120758","series-title":"Neurosurgery","first-page":"647","article-title":"Cyberknife radiosurgery for trigeminal neuralgia treatment: a preliminary multicenter experience","volume":"62","author":"Villavicencio","year":"2008"},{"key":"b39-1120758","series-title":"Neurology","first-page":"608","article-title":"Gamma Knife radiosurgery for treatment of trigeminal neuralgia: idiopathic and tumor related","volume":"48","author":"Young","year":"1997"},{"key":"b40-1120758","series-title":"Neurosurgery","first-page":"1304","article-title":"Patient reports of satisfaction after microvascular decompression and partial sensory rhizotomy for trigeminal neuralgia","volume":"56","author":"Zakrzewska","year":"2005"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/112\/4\/article-p758.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/112\/4\/article-p758.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/112\/4\/article-p758.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T07:35:51Z","timestamp":1679902551000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/112\/4\/article-p758.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2010,4]]},"references-count":40,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2009.7.jns09694","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2010,4]]}}}