{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T18:48:01Z","timestamp":1792176481302,"version":"4.4.0"},"reference-count":21,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Approximately 75%\u201392% of patients with trigeminal neuralgia (TN) achieve pain relief after Gamma Knife surgery (GKS), although a proportion of these patients will experience recurrence of their pain. To evaluate the reasons for durability or recurrence, this study determined the impact of trigeminal nerve length and volume, the nerve dose-volume relationship, and the presence of neurovascular compression (NVC) on pain outcomes after GKS for TN.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Fifty-eight patients with 60 symptomatic nerves underwent GKS for TN between 2013 and 2015, including 15 symptomatic nerves secondary to multiple sclerosis (MS). High-resolution MRI was acquired the day of GKS. The median maximum dose was 80 Gy for initial GKS and 65 Gy for repeat GKS. NVC, length and volume of the trigeminal nerve within the subarachnoid space of the posterior fossa, and the ratio of dose to nerve volume were assessed as predictors of recurrence.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Follow-up was available on 55 patients. Forty-nine patients (89.1%) reported pain relief (Barrow Neurological Institute [BNI] Grades I\u2013IIIb) after GKS at a median duration of 1.9 months. The probability of maintaining pain relief (BNI Grades I\u2013IIIb) without requiring resumption or an increase in medication was 93% at 1 year and 84% at 2 years for patients without MS, and 68% at 1 year and 51% at 2 years for all patients. The nerve length, nerve volume, target distance from the brainstem, and presence of NVC were not predictive of pain recurrence. Patients with a smaller volume of nerve (&lt; 35% of the total nerve volume) that received a high dose (\u2265 80% isodose) were less likely to experience recurrence of their TN pain after 1 year (mean time to recurrence: &lt; 35%, 32.2 \u00b1 4.0 months; &gt; 35%, 17.9 \u00b1 2.8 months, log-rank test, \u03c7<jats:sup>2<\/jats:sup> = 4.3, p = 0.039).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>The ratio of dose to nerve volume may predict recurrence of TN pain after GKS. Prospective studies are needed to determine the optimal dose to nerve volume ratio and whether this will result in longer pain-free outcomes.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2016.12.jns161862","type":"journal-article","created":{"date-parts":[[2017,5,19]],"date-time":"2017-05-19T13:59:29Z","timestamp":1495202369000},"page":"891-896","source":"Crossref","is-referenced-by-count":26,"title":["The relationship of dose to nerve volume in predicting pain recurrence after stereotactic radiosurgery in trigeminal neuralgia"],"prefix":"10.3171","volume":"128","author":[{"given":"Amparo","family":"Wolf","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York University, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Tyburczy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York University, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason Chao","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University of Southern California Keck School of Medicine, Los Angeles, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Girish","family":"Fatterpekar","sequence":"additional","affiliation":[{"name":"Departments of Medical Imaging and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua S.","family":"Silverman","sequence":"additional","affiliation":[{"name":"Radiation Oncology, NYU Langone Medical Center, New York University, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Kondziolka","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York University, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"666","DOI":"10.1227\/01.NEU.0000197117.34888.DE","article-title":"High-resolution three-dimensional magnetic resonance angiography and three-dimensional spoiled gradient-recalled imaging in the evaluation of neurovascular compression in patients with trigeminal neuralgia: a double-blind pilot study","volume":"58","author":"Anderson VC","year":"2006","unstructured":"Anderson VC, Berryhill PC, Sandquist MA, Ciaverella DP, Nesbit GM, Burchiel KJ: High-resolution three-dimensional magnetic resonance angiography and three-dimensional spoiled gradient-recalled imaging in the evaluation of neurovascular compression in patients with trigeminal neuralgia: a double-blind pilot study. 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