ObjectThe purpose of this study was to assess the efficacy of Gamma Knife surgery (GKS) in treating patients with trigeminal neuralgia (TN). Preliminary results of this study were previously reported. The updated results are reported in this paper.MethodsNinety seven patients with TN refractory to medical or surgical management underwent GKS between September 1998 and October 2005. Fifteen patients had multiple sclerosis (MS). The radiation dose was escalated from 70 to 99 Gy. The Barrow Neurological Institute Pain Scale (BNIPS) was used to assess pain before and after GKS.Eighty-four patients were available for evaluation with a mean follow up of 8.9 months. The overall response and complete response rates were 70.2% and 36.9%, respectively. At 12 months, there was a greater improvement in BNIPS scores for patients who were treated with two isocenters compared with those treated with a single isocenter. The mean percentage of pain decrease was 56.26% compared with 11.53% (p < 0.001). Patients treated with two isocenters rather than one and patients receiving greater than 85 Gy compared with lower doses had a longer duration of response. Only nine patients (11%) had mild numbness attributable to the GKS. Five of the nine patients experienced complete resolution of facial numbness on follow up. Patients with MS have a shorter duration of response compared with those without MS (p = 0.35).Conclusions These updated results show that GKS continues to be an effective therapy for TN. It appears there is an enhanced response with doses 85 Gy or more and with two isocenters without increased complications.

Medical inoperability does not necessarily correspond to poor survival in patients with early stage NSCLC. A nihilistic approach is not warranted towards this population, and prospective trials are needed to better define optimal treatment strategies.

Our data support the use of radiotherapy as a prophylactic treatment for the clinically negative neck. Tumor control in the clinically uninvolved cervical lymphatics is comparable to that in surgical series, suggesting that routine neck dissection may not be necessary. Prospective trials are necessary to further define the role of radiotherapy in this patient population.

No abstract

No abstract