{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T18:47:37Z","timestamp":1792176457147,"version":"4.4.0"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","license":[{"start":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T00:00:00Z","timestamp":1722470400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Recent studies have suggested that biologically effective dose (BED) is an important correlate of pain relief and sensory dysfunction after Gamma Knife radiosurgery (GKRS) for trigeminal neuralgia (TN). The goal of this study was to determine if BED is superior to prescription dose in predicting outcomes in TN patients undergoing GKRS as a first procedure.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>This was a retrospective study of 871 patients with type 1 TN from 13 GKRS centers. Patient demographics, pain characteristics, treatment parameters, and outcomes were reviewed. BED was compared with prescription dose and other dosimetric factors for their predictive value.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>The median age of the patients was 68 years, and 60% were female. Nearly 70% of patients experienced pain in the V2 and\/or V3 dermatomes, predominantly on the right side (60%). Most patients had modified BNI Pain Intensity Scale grade IV or V pain (89.2%) and were taking 1 or 2 pain medications (74.1%). The median prescription dose was 80 Gy (range 62.5\u201395 Gy). The proximal trigeminal nerve was targeted in 77.9% of cases, and the median follow-up was 21 months (range 6\u2013156 months). Initial pain relief (modified BNI Pain Intensity Scale grades I\u2013IIIa) was noted in 81.8% of evaluable patients at a median of 30 days. Of 709 patients who achieved initial pain relief, 42.3% experienced at least one pain recurrence after GKRS at a median of 44 months, with 49.0% of these patients undergoing a second procedure. New-onset facial numbness occurred in 25.3% of patients after a median of 8 months. Age \u2265 63 years was associated with a higher probability of both initial pain relief and maintaining pain relief. A distal target location was associated with a higher probability of initial and long-term pain relief, but also a higher incidence of sensory dysfunction. BED \u2265 2100 Gy<jats:sub>2.47<\/jats:sub> was predictive of pain relief at 30 days and 1 year for the distal target, whereas physical dose \u2265 85 Gy was significant for the proximal target, but the restricted range of BED values in this subgroup could be a confounding factor. A maximum brainstem point dose \u2265 29.5 Gy was associated with a higher probability of bothersome facial numbness.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>BED and physical dose were both predictive of pain relief and could be used as treatment planning goals for distal and proximal targets, respectively, while considering maximum brainstem point dose &lt; 29.5 Gy as a potential constraint for bothersome numbness.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.12.jns231569","type":"journal-article","created":{"date-parts":[[2024,2,17]],"date-time":"2024-02-17T01:25:57Z","timestamp":1708133157000},"page":"461-473","source":"Crossref","is-referenced-by-count":25,"title":["The relevance of biologically effective dose for pain relief and sensory dysfunction after Gamma Knife radiosurgery for trigeminal neuralgia: an 871-patient multicenter study"],"prefix":"10.3171","volume":"141","author":[{"given":"Ronald E.","family":"Warnick","sequence":"first","affiliation":[{"name":"Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Paddick","sequence":"additional","affiliation":[{"name":"Queen Square Radiosurgery Centre, London, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Mathieu","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of Sherbrooke, CHUS Research Center, Sherbrooke, Qu\u00e9bec, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Adam","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of Sherbrooke, CHUS Research Center, Sherbrooke, Qu\u00e9bec, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Iorio-Morin","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of Sherbrooke, CHUS Research Center, Sherbrooke, Qu\u00e9bec, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Leduc","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of Sherbrooke, CHUS Research Center, Sherbrooke, Qu\u00e9bec, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9anne","family":"Hamel","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of Sherbrooke, CHUS Research Center, Sherbrooke, Qu\u00e9bec, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah E.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad","family":"Bydon","sequence":"additional","affiliation":[{"name":"Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajay","family":"Niranjan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. Dade","family":"Lunsford","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhishuo","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaitlin","family":"Waite","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shalini","family":"Jose","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, 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