{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T04:04:19Z","timestamp":1784693059577,"version":"3.55.0"},"reference-count":26,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"Special_Supplement","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2010,12]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>The purpose of this study was to assess outcomes of Gamma Knife surgery (GKS) as a second treatment for recurrent or residual trigeminal neuralgia (TN) after failure of 3 initial procedures: microvascular decompression (MVD), GKS, and percutaneous radiofrequency rhizotomy (PRR).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Between 1999 and 2008, 65 patients (31 men [48%] and 34 women [52%]) with recurrent TN were treated with GKS. All 65 patients had undergone previous medical procedures that failed to achieve sufficient pain relief: 27 patients (42%) had undergone MVD, 8 (12%) had undergone PRR, and 30 (46%) had undergone GKS as the initial treatment. The entry zone of the trigeminal nerve was targeted using a 4-mm collimator and treated with 35\u201390 Gy. The isocenter was positioned so that the brainstem surface was usually irradiated at an isodose no greater than 20% (59 patients) to 30% (6 patients). The median duration of TN symptoms in these patients was 39 months (range 1\u2013192 months).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>At the clinical evaluation, 42 patients (65%) with idiopathic TN reported successful pain control at a median follow-up point of 64 months (range 18\u2013132 months). Of these patients, 33 (51%) were no longer using medication. At the 1-, 2-, and 3-year follow-up examinations, 74%, 71%, and 66% of patients experienced successful pain control, respectively. There was no significant difference in pain relief in the initial MVD group compared with the initial GKS and initial PRR groups (74% vs 59% and 50%, respectively; p = 0.342). Recurrence of pain was noted in 23 patients. Twelve of these 23 patients underwent another GKS, resulting in pain control in 8 patients (67%); 8 other patients underwent MVD, resulting in pain relief in 7 patients (87.5%). The median time from GKS to pain recurrence was 7 months (range 3\u201348 months). There was no significant difference in new facial numbness among the 3 groups (p = 0.24); however, in the initial GKS group, facial numbness was significantly associated with freedom from pain (p = 0.0012). There was a significant correlation between the total radiation dose and facial numbness. The cutoff value for facial numbness ranged from 115 to 120 Gy (p = 0.037).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Gamma Knife surgery as a second treatment achieved acceptable levels of pain control in 65% of patients with residual or recurrent TN after long-term follow-up. Initial treatment was not a factor that affected pain control, but salvage surgery may be considered separately for each group.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2010.8.gks10915","type":"journal-article","created":{"date-parts":[[2018,11,16]],"date-time":"2018-11-16T01:09:47Z","timestamp":1542330587000},"page":"172-177","source":"Crossref","is-referenced-by-count":26,"title":["Gamma Knife surgery for recurrent or residual trigeminal neuralgia after a failed initial procedure"],"prefix":"10.3171","volume":"113","author":[{"given":"Chuan-Fu","family":"Huang","sequence":"first","affiliation":[{"name":"Gamma Knife Center,"},{"name":"Department of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shyh-Ying","family":"Chiou","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Fang","family":"Wu","sequence":"additional","affiliation":[{"name":"Gamma Knife Center,"},{"name":"Department of Medical Oncology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsien-Tang","family":"Tu","sequence":"additional","affiliation":[{"name":"Gamma Knife Center,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Shan","family":"Liu","sequence":"additional","affiliation":[{"name":"Gamma Knife Center,"},{"name":"Department of Oncology Radiotherapy, Chung-Shan Medical University Hospital and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-1130172","series-title":"J Neurosurg","first-page":"916","article-title":"Repeat posterior fossa exploration for patients with persistent or recurrent idiopathic trigeminal neuralgia","volume":"108","author":"Amador","year":"2008"},{"key":"b2-1130172","series-title":"N Engl J Med","first-page":"1077","article-title":"The long-term outcome of microvascular decompression of trigeminal neuralgia","volume":"334","author":"Barker","year":"1996"},{"issue":"Suppl 3","key":"b3-1130172","series-title":"J Neurosurg","first-page":"159","article-title":"Gamma knife radiosurgery for primary management for trigeminal neuralgia","volume":"93","author":"Brisman","year":"2000"},{"key":"b4-1130172","series-title":"Neurosurgery","first-page":"1261","article-title":"Trigeminal nerve-blood vessel relationship as revealed by high-resolution magnetic resonance imaging and its effect on pain relief after gamma knife radiosurgery for trigeminal neuralgia","volume":"50","author":"Brisman","year":"2002"},{"key":"b5-1130172","series-title":"Neurosurgery","first-page":"783","article-title":"Long-term results of percutaneous retrogasserian thermorhizotomy for essential trigeminal neuralgia: considerations in 1000 consecutive patients","volume":"26","author":"Broggi","year":"1990"},{"key":"b6-1130172","series-title":"Neurosurgery","first-page":"665","article-title":"Repeat operations in failed microvascular decompression for trigeminal neuralgia","volume":"35","author":"Cho","year":"1994"},{"key":"b7-1130172","series-title":"J Neurosurg","first-page":"351","article-title":"Long-term outcomes of Gamma Knife radiosurgery for classic trigeminal neuralgia: implications of treatment and critical review of the literature. 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