{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T01:27:31Z","timestamp":1794014851127,"version":"4.8.0"},"reference-count":21,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Gamma Knife radiosurgery (GKRS) is a commonly used procedure for medically refractory trigeminal neuralgia (TN), with repeat GKRS routinely done in cases of pain relapse. The results of a third GKRS in cases of further pain relapse have not been well described. In this study, the authors report the largest series of patients treated with a third GKRS for TN to date.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Retrospective review of institutional electronic medical records and a GKRS database was performed to identify patients who had been treated with a third GKRS at the authors\u2019 institution in the period from 2010 to 2018. Telephone interviews were used to collect long-term follow-up data. Pain outcomes were measured using the Barrow Neurological Institute (BNI) pain intensity scale, with a score \u2264 IIIb indicating successful treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Twenty-two nerves in 21 patients had sufficient follow-up to determine BNI pain score outcomes. Eighteen of 22 cases had a successful third GKRS, with a median durability of pain relief of 3.88 years. There was no significant difference in the durability of pain relief after a third GKRS compared with those of institutional historical controls of prior series of first and second GKRS procedures. Ten cases had new or worsening facial numbness, with 1 case being bothersome. Four cases of toxicity other than facial numbness were reported, including 1 case of corneal abrasions and possible neurotrophic keratopathy. No cases of anesthesia dolorosa were reported. No factors predicting treatment success or the durability of pain relief were identified. Nonnumbness toxicity was more common in those with a proximally placed shot at the third GKRS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>A third GKRS is an effective treatment option for TN patients who have pain relapse after repeat GKRS. Pain outcomes of a third GKRS are similar to those following a first or second GKRS. Toxicity is tolerable in patients with a distally placed shot at the third GKRS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2020.2.jns192876","type":"journal-article","created":{"date-parts":[[2020,4,24]],"date-time":"2020-04-24T03:37:09Z","timestamp":1587699429000},"page":"1237-1243","source":"Crossref","is-referenced-by-count":11,"title":["Results of a third Gamma Knife radiosurgery for trigeminal neuralgia"],"prefix":"10.3171","volume":"134","author":[{"given":"Corbin A.","family":"Helis","sequence":"first","affiliation":[{"name":"Departments of Radiation Oncology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan T.","family":"Hughes","sequence":"additional","affiliation":[{"name":"Departments of Radiation Oncology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T.","family":"Munley","sequence":"additional","affiliation":[{"name":"Departments of Radiation Oncology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Daniel","family":"Bourland","sequence":"additional","affiliation":[{"name":"Departments of Radiation Oncology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Travis","family":"Jacobson","sequence":"additional","affiliation":[{"name":"Departments of Radiation Oncology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John T.","family":"Lucas","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, St. Jude Children\u2019s Research Hospital, Memphis, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina K.","family":"Cramer","sequence":"additional","affiliation":[{"name":"Departments of Radiation Oncology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen B.","family":"Tatter","sequence":"additional","affiliation":[{"name":"Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian W.","family":"Laxton","sequence":"additional","affiliation":[{"name":"Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D.","family":"Chan","sequence":"additional","affiliation":[{"name":"Departments of Radiation Oncology and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"Curr Neurol Neurosci Rep","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1007\/s11910-011-0242-7","article-title":"Surgical management of medically refractory trigeminal neuralgia","volume":"12","author":"Pollock\n \nBE","year":"2012","unstructured":"Pollock\n \nBE\n\n\n. \nSurgical management of medically refractory trigeminal neuralgia\n. \nCurr Neurol Neurosci Rep\n. \n2012\n;\n12\n(\n2\n):\n125\n\u2013\n131\n.\n10.1007\/s11910-011-0242-722183181"},{"issue":"4","key":"b2","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"758","DOI":"10.3171\/2009.7.JNS09694","article-title":"Gamma Knife stereotactic radiosurgery for idiopathic trigeminal neuralgia","volume":"112","author":"Kondziolka\n \nD","year":"2010","unstructured":"Kondziolka\n \nD\n\n, \n\nZorro\n \nO\n\n, \n\nLobato-Polo\n \nJ\n\n, \n\n\n \nGamma Knife stereotactic radiosurgery for idiopathic trigeminal neuralgia\n. \nJ Neurosurg\n. \n2010\n;\n112\n(\n4\n):\n758\n\u2013\n765\n.\n10.3171\/2009.7.JNS0969419747055"},{"issue":"3","key":"b3","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1227\/NEU.0b013e3182320d36","article-title":"Predictive variables for the successful treatment of trigeminal neuralgia with Gamma Knife radiosurgery","volume":"70","author":"Marshall\n \nK","year":"2012","unstructured":"Marshall\n \nK\n\n, \n\nChan\n \nMD\n\n, \n\nMcCoy\n \nTP\n\n, \n\n\n \nPredictive variables for the successful treatment of trigeminal neuralgia with Gamma Knife radiosurgery\n. \nNeurosurgery\n. \n2012\n;\n70\n(\n3\n):\n566\n\u2013\n573\n.\n2184991810.1227\/NEU.0b013e3182320d36"},{"issue":"4","key":"b4","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1079","DOI":"10.3171\/2015.2.JNS142144","article-title":"Long-term safety and efficacy of Gamma Knife surgery in classical trigeminal neuralgia: a 497-patient historical cohort study","volume":"124","author":"R\u00e9gis\n \nJ","year":"2016","unstructured":"R\u00e9gis\n \nJ\n\n, \n\nTuleasca\n \nC\n\n, \n\nResseguier\n \nN\n\n, \n\n\n \nLong-term safety and efficacy of Gamma Knife surgery in classical trigeminal neuralgia: a 497-patient historical cohort study\n. \nJ Neurosurg\n. \n2016\n;\n124\n(\n4\n):\n1079\n\u2013\n1087\n.\n10.3171\/2015.2.JNS14214426339857"},{"issue":"5","key":"b5","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1227\/NEU.0000000000000915","article-title":"Repeat radiosurgery for trigeminal neuralgia","volume":"77","author":"Helis\n \nCA","year":"2015","unstructured":"Helis\n \nCA\n\n, \n\nLucas\n \nJT\n \nJr\n\n, \n\nBourland\n \nJD\n\n, \n\n\n \nRepeat radiosurgery for trigeminal neuralgia\n. \nNeurosurgery\n. \n2015\n;\n77\n(\n5\n):\n755\n\u2013\n761\n.\n10.1227\/NEU.000000000000091526214319"},{"issue":"2","key":"b6","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1227\/NEU.0b013e318230218e","article-title":"Repeat gamma knife radiosurgery for trigeminal neuralgia","volume":"70","author":"Park\n \nK-J","year":"2012","unstructured":"Park\n \nK-J\n\n, \n\nKondziolka\n \nD\n\n, \n\nBerkowitz\n \nO\n\n, \n\n\n \nRepeat gamma knife radiosurgery for trigeminal neuralgia\n. \nNeurosurgery\n. \n2012\n;\n70\n(\n2\n):\n295\n\u2013\n305\n.\n10.1227\/NEU.0b013e318230218e21811188"},{"issue":"6","key":"b7","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1324","DOI":"10.3171\/2014.9.JNS13959","article-title":"A successful case of multiple stereotactic radiosurgeries for ipsilateral recurrent trigeminal neuralgia","volume":"122","author":"Daugherty\n \nE","year":"2015","unstructured":"Daugherty\n \nE\n\n, \n\nBhavsar\n \nS\n\n, \n\nHahn\n \nSS\n\n, \n\n\n \nA successful case of multiple stereotactic radiosurgeries for ipsilateral recurrent trigeminal neuralgia\n. \nJ Neurosurg\n. \n2015\n;\n122\n(\n6\n):\n1324\n\u2013\n1329\n.\n2581608310.3171\/2014.9.JNS13959"},{"issue":"12","key":"b8","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"1405","DOI":"10.1136\/jnnp.2007.142794","article-title":"Recurrent trigeminal neuralgia: long term outcome of repeat gamma knife radiosurgery","volume":"79","author":"Gellner\n \nV","year":"2008","unstructured":"Gellner\n \nV\n\n, \n\nKurschel\n \nS\n\n, \n\nKreil\n \nW\n\n, \n\n\n \nRecurrent trigeminal neuralgia: long term outcome of repeat gamma knife radiosurgery\n. \nJ Neurol Neurosurg Psychiatry\n. \n2008\n;\n79\n(\n12\n):\n1405\n\u2013\n1407\n.\n1842072510.1136\/jnnp.2007.142794"},{"key":"b9","series-title":"Case Rep Med","doi-asserted-by":"publisher","first-page":"258910","DOI":"10.1155\/2011\/258910","article-title":"Feasibility of multiple repeat gamma knife radiosurgeries for trigeminal neuralgia: a case report and review of the literature","volume":"2011","author":"Jones\n \nGC","year":"2011","unstructured":"Jones\n \nGC\n\n, \n\nElaimy\n \nAL\n\n, \n\nDemakas\n \nJJ\n\n, \n\n\n \nFeasibility of multiple repeat gamma knife radiosurgeries for trigeminal neuralgia: a case report and review of the literature\n. \nCase Rep Med\n. \n2011\n;\n2011\n:\n258910\n.\n2190455610.1155\/2011\/258910"},{"issue":"1","key":"b10","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"169","DOI":"10.3171\/2014.9.JNS132779","article-title":"The results of a third Gamma Knife procedure for recurrent trigeminal neuralgia","volume":"122","author":"Tempel\n \nZJ","year":"2015","unstructured":"Tempel\n \nZJ\n\n, \n\nChivukula\n \nS\n\n, \n\nMonaco\n \nEA\n \nIII\n\n, \n\n\n \nThe results of a third Gamma Knife procedure for recurrent trigeminal neuralgia\n. \nJ Neurosurg\n. \n2015\n;\n122\n(\n1\n):\n169\n\u2013\n179\n.\n2536148210.3171\/2014.9.JNS132779"},{"issue":"5","key":"b11","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1164","DOI":"10.1227\/01.NEU.0000088806.11659.D8","article-title":"A new classification for facial pain","volume":"53","author":"Burchiel\n \nKJ","year":"2003","unstructured":"Burchiel\n \nKJ\n\n\n. \nA new classification for facial pain\n. \nNeurosurgery\n. \n2003\n;\n53\n(\n5\n):\n1164\n\u2013\n1167\n.\n1458028410.1227\/01.NEU.0000088806.11659.D8"},{"issue":"5","key":"b12","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"E933","DOI":"10.1093\/neuros\/nyz182","article-title":"Gamma Knife radiosurgery for multiple sclerosis-associated trigeminal neuralgia","volume":"85","author":"Helis\n \nCA","year":"2019","unstructured":"Helis\n \nCA\n\n, \n\nMcTyre\n \nE\n\n, \n\nMunley\n \nMT\n\n, \n\n\n \nGamma Knife radiosurgery for multiple sclerosis-associated trigeminal neuralgia\n. \nNeurosurgery\n. \n2019\n;\n85\n(\n5\n):\nE933\n\u2013\nE939\n.\n10.1093\/neuros\/nyz18231173108"},{"issue":"5","key":"b13","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1591","DOI":"10.3171\/2018.6.JNS172646","article-title":"Gamma Knife radiosurgery for bilateral trigeminal neuralgia","volume":"131","author":"Helis\n \nCA","year":"2019","unstructured":"Helis\n \nCA\n\n, \n\nMcTyre\n \nE\n\n, \n\nMunley\n \nMT\n\n, \n\n\n \nGamma Knife radiosurgery for bilateral trigeminal neuralgia\n. \nJ Neurosurg\n. \n2019\n;\n131\n(\n5\n):\n1591\n\u2013\n1598\n.\n10.3171\/2018.6.JNS172646"},{"issue":"3","key":"b14","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"716","DOI":"10.3171\/2013.10.JNS131596","article-title":"Impact of target location on the response of trigeminal neuralgia to stereotactic radiosurgery","volume":"120","author":"Xu\n \nZ","year":"2014","unstructured":"Xu\n \nZ\n\n, \n\nSchlesinger\n \nD\n\n, \n\nMoldovan\n \nK\n\n, \n\n\n \nImpact of target location on the response of trigeminal neuralgia to stereotactic radiosurgery\n. \nJ Neurosurg\n. \n2014\n;\n120\n(\n3\n):\n716\n\u2013\n724\n.\n2431361610.3171\/2013.10.JNS131596"},{"issue":"2","key":"b15","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"452","DOI":"10.3171\/2016.10.JNS16747","article-title":"A proposed plan for personalized radiosurgery in patients with trigeminal neuralgia","volume":"128","author":"Mousavi\n \nSH","year":"2018","unstructured":"Mousavi\n \nSH\n\n, \n\nNiranjan\n \nA\n\n, \n\nAkpinar\n \nB\n\n, \n\n\n \nA proposed plan for personalized radiosurgery in patients with trigeminal neuralgia\n. \nJ Neurosurg\n. \n2018\n;\n128\n(\n2\n):\n452\n\u2013\n459\n.\n10.3171\/2016.10.JNS1674728298016"},{"issue":"4","key":"b16","series-title":"Int J Radiat Oncol Biol Phys","doi-asserted-by":"publisher","first-page":"1013","DOI":"10.1016\/S0360-3016(00)00513-7","article-title":"Gamma Knife radiosurgery for trigeminal neuralgia: the initial experience of The Barrow Neurological Institute","volume":"47","author":"Rogers\n \nCL","year":"2000","unstructured":"Rogers\n \nCL\n\n, \n\nShetter\n \nAG\n\n, \n\nFiedler\n \nJA\n\n, \n\n\n \nGamma Knife radiosurgery for trigeminal neuralgia: the initial experience of The Barrow Neurological Institute\n. \nInt J Radiat Oncol Biol Phys\n. \n2000\n;\n47\n(\n4\n):\n1013\n\u2013\n1019\n.\n10.1016\/S0360-3016(00)00513-710863073"},{"issue":"3","key":"b17","series-title":"Neurosurg Clin N Am","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1016\/j.nec.2016.02.005","article-title":"Percutaneous procedures for the treatment of trigeminal neuralgia","volume":"27","author":"Wang\n \nJY","year":"2016","unstructured":"Wang\n \nJY\n\n, \n\nBender\n \nMT\n\n, \n\nBettegowda\n \nC\n\n\n. \nPercutaneous procedures for the treatment of trigeminal neuralgia\n. \nNeurosurg Clin N Am\n. \n2016\n;\n27\n(\n3\n):\n277\n\u2013\n295\n.\n10.1016\/j.nec.2016.02.00527324995"},{"issue":"2","key":"b18","series-title":"Int Ophthalmol Clin","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1097\/IIO.0000000000000170","article-title":"Effects of aging in dry eye","volume":"57","author":"de Paiva\n \nCS","year":"2017","unstructured":"de Paiva\n \nCS\n\n\n. \nEffects of aging in dry eye\n. \nInt Ophthalmol Clin\n. \n2017\n;\n57\n(\n2\n):\n47\n\u2013\n64\n.\n2828231410.1097\/IIO.0000000000000170"},{"issue":"4","key":"b19","series-title":"Neurosurgery","first-page":"971","article-title":"Histological effects of trigeminal nerve radiosurgery in a primate model: implications for trigeminal neuralgia radiosurgery","volume":"46","author":"Kondziolka\n \nD","year":"2000","unstructured":"Kondziolka\n \nD\n\n, \n\nLacomis\n \nD\n\n, \n\nNiranjan\n \nA\n\n, \n\n\n \nHistological effects of trigeminal nerve radiosurgery in a primate model: implications for trigeminal neuralgia radiosurgery\n. \nNeurosurgery\n. \n2000\n;\n46\n(\n4\n):\n971\n\u2013\n977\n."},{"issue":"4","key":"b20","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1093\/neuros\/nyy122","article-title":"Trigeminal nerve atrophy predicts pain recurrence after Gamma Knife stereotactic radiosurgery for classical trigeminal neuralgia","volume":"84","author":"Hu\n \nY-S","year":"2019","unstructured":"Hu\n \nY-S\n\n, \n\nLee\n \nC-C\n\n, \n\nGuo\n \nW-Y\n\n, \n\n\n \nTrigeminal nerve atrophy predicts pain recurrence after Gamma Knife stereotactic radiosurgery for classical trigeminal neuralgia\n. \nNeurosurgery\n. \n2019\n;\n84\n(\n4\n):\n927\n\u2013\n934\n.\n2966004710.1093\/neuros\/nyy122"},{"issue":"3","key":"b21","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"891","DOI":"10.3171\/2016.12.JNS161862","article-title":"The relationship of dose to nerve volume in predicting pain recurrence after stereotactic radiosurgery in trigeminal neuralgia","volume":"128","author":"Wolf\n \nA","year":"2018","unstructured":"Wolf\n \nA\n\n, \n\nTyburczy\n \nA\n\n, \n\nYe\n \nJC\n\n, \n\n\n \nThe relationship of dose to nerve volume in predicting pain recurrence after stereotactic radiosurgery in trigeminal neuralgia\n. \nJ Neurosurg\n. \n2018\n;\n128\n(\n3\n):\n891\n\u2013\n896\n.\n10.3171\/2016.12.JNS16186228524797"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/134\/4\/article-p1237.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/134\/4\/article-p1237.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/134\/4\/article-p1237.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T01:12:51Z","timestamp":1794013971000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/134\/4\/article-p1237.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4]]},"references-count":21,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2020.2.jns192876","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4]]}}}