Object Stereotactic radiosurgery (SRS) with the Gamma Knife (GK) is a rapidly emerging surgical modality in the management of medically refractory idiopathic trigeminal neuralgia (TN). The current study examines the long-term outcome in patients with drug-resistant idiopathic TN who underwent GK surgery at the authors‘ institution. Methods One hundred and six consecutive patients (38 men and 68 women) with proven medically refractory idiopathic TN were included in this retrospective study. Their ages were 41–82 years (mean 72.3 years). All patients underwent SRS with prescribed maximal radiation doses ranging from 70 to 85 Gy. Isocenters 1–3 were used and plugging was used selectively. The follow-up period was 12–72 months (mean 34.3 months). The patients were divided into 2 groups according to their history of previous surgery. Results The initial response rate in patients with no history of previous surgery was 92.9%; in those who had undergone previous surgery, the initial response rate was 85.7%. At the end of the 1st posttreatment year, an excellent outcome was achieved in 82.5% of patients who had not had previous surgery, and in 69.4% of those who had. The respective outcome rates for the 2nd posttreatment year were 78 and 63.5%, respectively. The most common complication was the development of persistent paresthesia, which occurred in 15.8% of patients with no previous surgery and 16.3% of those with previous surgery. Conclusions Stereotactic radiosurgery with the GK is a safe and effective treatment option for patients with medically refractory idiopathic TN.

Trigeminal neuralgia (TN) is a chronic pain condition causing lancinating pain in the distribution of one or more divisions of the trigeminal nerve. Gamma knife stereotactic radiosurgery (GKSRS) is a surgical option for TN refractory to medical therapy. To report our experience and to analyze the reasons for the variance in radiosurgery outcomes between patients in our diverse population, we conducted a retrospective analysis of a prospectively created database. The 178 patients completed a pain assessment questionnaire before surgery, and at 1 and 2 year follow-ups. We used the “Trigeminal Neuralgia Gamma Knife Outcome Scale” (TN GKOS) to report the response. At 1-year, 35.4% of patients had grade 1A outcome (pain-free and off all pain medications), 24.7% had grade 1B (pain-free on pain medications), 24.2% had grade 1C (some pain but improved with radiosurgery), 12.9% had grade 2 (same as before radiosurgery) and 2.8% had grade 3 (worse pain compared to before radiosurgery). At 2 years, 42.3% had grade 1A, 20.5% had grade 1B, 19.2% had grade 1C, 14.1% had grade 2 and 3.8% had grade 3 outcome. Remarkably, a statistically significant association was found between GKOS and age, racial background and obesity.

Conclusion: In a large cohort of community and academic patients, we did not find an independent association between radiation treatment schedule and OS in early stage NSCLC patients. Our findings suggest that dose escalation beyond 100 Gy BED 10 may improve patient survival.