Outcomes and predictive factors after second stereotactic radiosurgery for refractory trigeminal neuralgia
ObjectivesThis study evaluates the safety and efficacy of Gamma Knife Stereotactic Radiosurgery (GKSRS) retreatment (T2) for recurrent or refractory trigeminal neuralgia (TN) following an initial SRS treatment (T1). Methods: We analyzed 53 patients who underwent T2 between 2012 and 2018 using a pros...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-07-01
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| Series: | Clinical and Translational Radiation Oncology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S240563082500059X |
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| author | Bailey A. Loving Jacob F. Oyeniyi Siddharth Ramanathan Joseph S. Lee Hong Ye Yastira Ramdas Inga S. Grills James F. Fontanesi Prakash Chinnaiyan Daniel K. Fahim Daniel B. Michael Peter Y. Chen |
| author_facet | Bailey A. Loving Jacob F. Oyeniyi Siddharth Ramanathan Joseph S. Lee Hong Ye Yastira Ramdas Inga S. Grills James F. Fontanesi Prakash Chinnaiyan Daniel K. Fahim Daniel B. Michael Peter Y. Chen |
| author_sort | Bailey A. Loving |
| collection | DOAJ |
| description | ObjectivesThis study evaluates the safety and efficacy of Gamma Knife Stereotactic Radiosurgery (GKSRS) retreatment (T2) for recurrent or refractory trigeminal neuralgia (TN) following an initial SRS treatment (T1). Methods: We analyzed 53 patients who underwent T2 between 2012 and 2018 using a prospectively maintained single institution database. Baseline characteristics, treatment details, and toxicity data were assessed, with pain responses evaluated via Barrow Neurological Institute (BNI) pain intensity scores. Predictors of pain recurrence and chronic sensory toxicity were identified using univariate and multivariable analyses. Results: The median T2 maximum dose was 70 Gy, primarily targeting the cisternal segment (43 %) and retrogasserian zone (RGZ) (34 %). Following T2, 95 % experienced initial pain relief with a 1-month median time to response, and 1-, 2-, and 3-year freedom from pain recurrence of 51 %, 45 %, and 41 %, respectively. Chronic sensory deficits were observed in 62 % of patients, but motor toxicity remained rare (mastication deficit: 2.5 %; facial motor deficit: 5.1 %). RGZ targeting (HR = 3.84, p = 0.02) and single isocenter treatments (HR = 3.85, p = 0.04) were predictive of pain recurrence when compared to dorsal root entry zone (DREZ) targeting and two isocenters, respectively. Affected trigeminal nerve length <11.5 mm was associated with chronic sensory deficits (OR = 7.14, p = 0.02). Conclusion: GKSRS provides effective pain relief and manageable toxicity in retreatment for refractory/recurrent TN. Optimizing parameters, including DREZ targeting and dual-isocenter strategies, can enhance outcomes, while balancing treatment length to mitigate chronic sensory toxicity. Future research should aim at optimizing treatment parameters to maximize pain relief while minimizing toxicity for these patients. |
| format | Article |
| id | doaj-art-e525e89f92fd4224b73fc4efbea5a7f6 |
| institution | Kabale University |
| issn | 2405-6308 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical and Translational Radiation Oncology |
| spelling | doaj-art-e525e89f92fd4224b73fc4efbea5a7f62025-08-20T03:30:49ZengElsevierClinical and Translational Radiation Oncology2405-63082025-07-015310096910.1016/j.ctro.2025.100969Outcomes and predictive factors after second stereotactic radiosurgery for refractory trigeminal neuralgiaBailey A. Loving0Jacob F. Oyeniyi1Siddharth Ramanathan2Joseph S. Lee3Hong Ye4Yastira Ramdas5Inga S. Grills6James F. Fontanesi7Prakash Chinnaiyan8Daniel K. Fahim9Daniel B. Michael10Peter Y. Chen11Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI, United States; Corresponding authors.Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI, United StatesDepartment of General Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, MI, United StatesDepartment of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI, United States; Corresponding authors.Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI, United StatesDepartment of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI, United StatesDepartment of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI, United StatesDepartment of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI, United StatesDepartment of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI, United StatesMichigan Head and Spine Institute, Royal Oak, MI, United StatesMichigan Head and Spine Institute, Royal Oak, MI, United StatesDepartment of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI, United StatesObjectivesThis study evaluates the safety and efficacy of Gamma Knife Stereotactic Radiosurgery (GKSRS) retreatment (T2) for recurrent or refractory trigeminal neuralgia (TN) following an initial SRS treatment (T1). Methods: We analyzed 53 patients who underwent T2 between 2012 and 2018 using a prospectively maintained single institution database. Baseline characteristics, treatment details, and toxicity data were assessed, with pain responses evaluated via Barrow Neurological Institute (BNI) pain intensity scores. Predictors of pain recurrence and chronic sensory toxicity were identified using univariate and multivariable analyses. Results: The median T2 maximum dose was 70 Gy, primarily targeting the cisternal segment (43 %) and retrogasserian zone (RGZ) (34 %). Following T2, 95 % experienced initial pain relief with a 1-month median time to response, and 1-, 2-, and 3-year freedom from pain recurrence of 51 %, 45 %, and 41 %, respectively. Chronic sensory deficits were observed in 62 % of patients, but motor toxicity remained rare (mastication deficit: 2.5 %; facial motor deficit: 5.1 %). RGZ targeting (HR = 3.84, p = 0.02) and single isocenter treatments (HR = 3.85, p = 0.04) were predictive of pain recurrence when compared to dorsal root entry zone (DREZ) targeting and two isocenters, respectively. Affected trigeminal nerve length <11.5 mm was associated with chronic sensory deficits (OR = 7.14, p = 0.02). Conclusion: GKSRS provides effective pain relief and manageable toxicity in retreatment for refractory/recurrent TN. Optimizing parameters, including DREZ targeting and dual-isocenter strategies, can enhance outcomes, while balancing treatment length to mitigate chronic sensory toxicity. Future research should aim at optimizing treatment parameters to maximize pain relief while minimizing toxicity for these patients.http://www.sciencedirect.com/science/article/pii/S240563082500059XRefractory trigeminal neuralgiaStereotactic radiosurgeryRetreatment |
| spellingShingle | Bailey A. Loving Jacob F. Oyeniyi Siddharth Ramanathan Joseph S. Lee Hong Ye Yastira Ramdas Inga S. Grills James F. Fontanesi Prakash Chinnaiyan Daniel K. Fahim Daniel B. Michael Peter Y. Chen Outcomes and predictive factors after second stereotactic radiosurgery for refractory trigeminal neuralgia Clinical and Translational Radiation Oncology Refractory trigeminal neuralgia Stereotactic radiosurgery Retreatment |
| title | Outcomes and predictive factors after second stereotactic radiosurgery for refractory trigeminal neuralgia |
| title_full | Outcomes and predictive factors after second stereotactic radiosurgery for refractory trigeminal neuralgia |
| title_fullStr | Outcomes and predictive factors after second stereotactic radiosurgery for refractory trigeminal neuralgia |
| title_full_unstemmed | Outcomes and predictive factors after second stereotactic radiosurgery for refractory trigeminal neuralgia |
| title_short | Outcomes and predictive factors after second stereotactic radiosurgery for refractory trigeminal neuralgia |
| title_sort | outcomes and predictive factors after second stereotactic radiosurgery for refractory trigeminal neuralgia |
| topic | Refractory trigeminal neuralgia Stereotactic radiosurgery Retreatment |
| url | http://www.sciencedirect.com/science/article/pii/S240563082500059X |
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