{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T15:12:14Z","timestamp":1767625934528,"version":"3.44.0"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T00:00:00Z","timestamp":1756080000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p>We report the results of a long-term follow-up series in our center to verify the impact of biologically effective dose (BED) on the efficacy and safety of Gamma Knife radiosurgery (GKS) in the treatment of primary trigeminal neuralgia (TN). A total of 138 consecutive cases of primary TN receiving GKS were included. A 4-mm collimator was used for all cases, and a median central dose of 85\u202fGy (range 70\u201390\u202fGy) was prescribed. The Barrow Neurological Institute Pain Scale was adopted to evaluate the severity of TN. The median follow-up period was 65.5\u202fmonths (range 12\u2013147\u202fmonths). Overall, 123 (89.1%) patients eventually achieved effective relief. The influence of BED on treatment outcomes varied by target location. For patients with distal targets, BED was a significant predictor of treatment failure (OR: 0.996, 95% CI: 0.992\u20130.999, <jats:italic>p<\/jats:italic>\u202f=\u202f0.02) and post-GKS complications (OR: 1.002, 95% CI: 1.000\u20131.004, <jats:italic>p<\/jats:italic>\u202f=\u202f0.01). However, BED did not significantly influence outcomes in the proximal target subgroup, either for treatment failure or complications. No significant association was found between BED and long-term outcomes in the entire cohort or in any subgroup analysis. Adjusting GKS doses according to BED for the distal target may optimize clinical outcomes in TN patients.<\/jats:p>","DOI":"10.3389\/fneur.2025.1614981","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T05:25:59Z","timestamp":1756099559000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Differential impact of biologically effective dose in distal versus proximal gamma knife targets for trigeminal neuralgia"],"prefix":"10.3389","volume":"16","author":[{"given":"Hao","family":"Deng","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuan","family":"Gao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yang","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mengqi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linglong","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Runlin","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhujun","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Pan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"570","DOI":"10.1016\/j.adaj.2016.02.014","article-title":"Prevalence of trigeminal neuralgia: a systematic review","volume":"147","author":"De Toledo","year":"2016","journal-title":"J Am Dent Assoc"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"754","DOI":"10.1056\/NEJMra1914484","article-title":"Trigeminal neuralgia","volume":"383","author":"Cruccu","year":"2020","journal-title":"N Engl J Med"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1111\/j.1533-2500.2006.00079.x","article-title":"Patient burden of trigeminal neuralgia: results from a cross-sectional survey of health state impairment and treatment patterns in six European countries","volume":"6","author":"T\u00f6lle","year":"2006","journal-title":"Pain Pract"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"386","DOI":"10.3390\/medicina47070055","article-title":"Associations between chronic pain and depressive symptoms in patients with trigeminal neuralgia","volume":"47","author":"Ma\u010dianskyt\u0117","year":"2011","journal-title":"Medicina (Kaunas)"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1186\/s10194-015-0548-y","article-title":"Risk of psychiatric disorders following trigeminal neuralgia: a nationwide population-based retrospective cohort study","volume":"16","author":"Wu","year":"2015","journal-title":"J Headache Pain"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1166","DOI":"10.1097\/j.pain.0000000000000853","article-title":"Evaluating the impact of trigeminal neuralgia","volume":"158","author":"Zakrzewska","year":"2017","journal-title":"Pain"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"831","DOI":"10.1111\/ene.13950","article-title":"European academy of neurology guideline on trigeminal neuralgia","volume":"26","author":"Bendtsen","year":"2019","journal-title":"Eur J Neurol"},{"key":"ref8","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":"Regis","year":"2016","journal-title":"J Neurosurg"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1227\/NEU.0000000000001404","article-title":"Long-term outcomes in the treatment of classical trigeminal neuralgia by gamma knife radiosurgery: a retrospective study in patients with minimum 2-year follow-up","volume":"79","author":"Mart\u00ednez Moreno","year":"2016","journal-title":"Neurosurgery"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"733","DOI":"10.3171\/2017.9.JNS17545","article-title":"Stereotactic radiosurgery for trigeminal neuralgia: a systematic review","volume":"130","author":"Tuleasca","year":"2018","journal-title":"J Neurosurg"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1259\/bjr\/31372149","article-title":"21 years of biologically effective dose","volume":"83","author":"Fowler","year":"2010","journal-title":"Br J Radiol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1016\/j.ejmp.2015.04.008","article-title":"The role of the concept of biologically effective dose (BED) in treatment planning in radiosurgery","volume":"31","author":"Millar","year":"2015","journal-title":"Phys Med"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1288","DOI":"10.3390\/jcm12041288","article-title":"Gamma knife radiosurgery for Cushing's disease: evaluation of biological effective dose from a single-center experience","volume":"12","author":"Gao","year":"2023","journal-title":"J Clin Med"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"E330","DOI":"10.1093\/neuros\/nyaa555","article-title":"Biological effective dose as a predictor of hypopituitarism after single-fraction pituitary adenoma radiosurgery: dosimetric analysis and cohort study of patients treated using contemporary techniques","volume":"88","author":"Graffeo","year":"2021","journal-title":"Neurosurgery"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1227\/NEU.0000000000001755","article-title":"Importance of Cobalt-60 dose rate and biologically effective dose on local control for intracranial Meningiomas treated with stereotactic radiosurgery","volume":"90","author":"Huo","year":"2022","journal-title":"Neurosurgery"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1157","DOI":"10.1016\/j.mayocp.2020.09.041","article-title":"The role of biological effective dose in predicting obliteration after stereotactic radiosurgery of cerebral arteriovenous malformations","volume":"96","author":"Nesvick","year":"2021","journal-title":"Mayo Clin Proc"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1901","DOI":"10.3171\/2020.4.JNS201250","article-title":"Biologically effective dose and prediction of obliteration of unruptured arteriovenous malformations treated by upfront gamma knife radiosurgery: a series of 149 consecutive cases","volume":"134","author":"Tuleasca","year":"2020","journal-title":"J Neurosurg"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"461","DOI":"10.3171\/2023.12.JNS231569","article-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","volume":"141","author":"Warnick","year":"2024","journal-title":"J Neurosurg"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1016\/j.neuchi.2009.02.001","article-title":"Structural anatomy of cranial nerves (V, VII, VIII, IX, X)","volume":"55","author":"Guclu","year":"2009","journal-title":"Neurochirurgie"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"2365","DOI":"10.1007\/s00701-011-1168-1","article-title":"Cranial nerve vascular compression syndromes of the trigeminal, facial and vago-glossopharyngeal nerves: comparative anatomical study of the central myelin portion and transitional zone; correlations with incidences of corresponding hyperactive dysfunctional syndromes","volume":"153","author":"Guclu","year":"2011","journal-title":"Acta Neurochir"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"von Elm","year":"2007","journal-title":"Lancet"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1177\/0333102413485658","article-title":"The international classification of headache disorders, 3rd edition (beta version)","volume":"33","year":"2013","journal-title":"Cephalalgia"},{"key":"ref23","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","year":"2000","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"20180111","DOI":"10.1259\/bjr.20180111","article-title":"Modelling the influence of treatment time on the biological effectiveness of single radiosurgery treatments: derivation of \"protective\" dose modification factors","volume":"92","author":"Jones","year":"2019","journal-title":"Br J Radiol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"168","DOI":"10.3171\/2010.7.GKS101049","article-title":"Does the gamma knife dose rate affect outcomes in radiosurgery for trigeminal neuralgia?","volume":"113","author":"Arai","year":"2010","journal-title":"J Neurosurg"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"730","DOI":"10.3171\/jns.2006.105.5.730","article-title":"Does dose rate affect efficacy? The outcomes of 256 gamma knife surgery procedures for trigeminal neuralgia and other types of facial pain as they relate to the half-life of cobalt","volume":"105","author":"Balamucki","year":"2006","journal-title":"J Neurosurg"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"961","DOI":"10.3171\/2014.12.JNS142013","article-title":"Higher dose rate gamma knife radiosurgery may provide earlier and longer-lasting pain relief for patients with trigeminal neuralgia","volume":"123","author":"Lee","year":"2015","journal-title":"J Neurosurg"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"2797","DOI":"10.1007\/s10143-021-01474-9","article-title":"Factors affecting long-lasting pain relief after gamma knife radiosurgery for trigeminal neuralgia: a single institutional analysis and literature review","volume":"44","author":"Barzaghi","year":"2021","journal-title":"Neurosurg Rev"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"160","DOI":"10.3171\/2010.7.GKS10978","article-title":"Gamma knife surgery for trigeminal neuralgia: a review of 450 consecutive cases","volume":"113","author":"Verheul","year":"2010","journal-title":"J Neurosurg"},{"key":"ref30","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","year":"2010","journal-title":"J Neurosurg"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1111\/cen.14346","article-title":"Gamma knife radiosurgery for acromegaly: evaluating the role of the biological effective dose associated with endocrine remission in a series of 42 consecutive cases","volume":"94","author":"Balossier","year":"2021","journal-title":"Clin Endocrinol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1016\/j.ijrobp.2014.01.023","article-title":"Predictive nomogram for the durability of pain relief from gamma knife radiation surgery in the treatment of trigeminal neuralgia","volume":"89","author":"Lucas","year":"2014","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"ref33","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","year":"2018","journal-title":"J Neurosurg"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"e15194","DOI":"10.7759\/cureus.15194","article-title":"Gamma ray radiosurgery for trigeminal neuralgia: targeting proximal or distal to the dorsal root entry zone","volume":"13","author":"Lovo","year":"2021","journal-title":"Cureus"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"e204","DOI":"10.1016\/j.wneu.2019.10.021","article-title":"Establishment of a therapeutic ratio for gamma knife radiosurgery of trigeminal neuralgia: the critical importance of biologically effective dose versus physical dose","volume":"134","author":"Tuleasca","year":"2020","journal-title":"World Neurosurg"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1590\/S0004-282X2001000300009","article-title":"Behaviour of oligodendrocytes and Schwann cells in an experimental model of toxic demyelination of the central nervous system","volume":"59","author":"Gra\u00e7a","year":"2001","journal-title":"Arq Neuropsiquiatr"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1614981\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T05:26:01Z","timestamp":1756099561000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1614981\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,25]]},"references-count":36,"alternative-id":["10.3389\/fneur.2025.1614981"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2025.1614981","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,25]]},"article-number":"1614981"}}