Radiation Oncology/CNS/Trigeminal neuralgia/Retrospective

Trigeminal Neuralgia Retrospective Studies
 * Maryland
 * 2007 (1996-2004) PMID 17467919 -- "Efficacy and quality of life outcomes in patients with atypical trigeminal neuralgia treated with gamma-knife radiosurgery." (Dhople A, Int J Radiat Oncol Biol Phys. 2007 Oct 1;69(2):397-403. Epub 2007 Apr 30.)
 * Retrospective. 35 patients with atypical TN, Group I (atypical TN) 57%, Group II (typical progress to atypical) 43%. RT median 75 Gy (70-80 Gy). Median F/U 2.4 years
 * Pain control: 72% excellent/good relief, mean time to relief 5.8 weeks (0-24). Mean duration of relief 14 months. Comparable to typical TN at same institution
 * Side effects: 19% bothersome numbness
 * Conclusion: Aytpical TN similar outcomes to classical TN
 * 2003 PMID 12829153 1996-2001 -- "Radiosurgical treatment of trigeminal neuralgia: evaluating quality of life and treatment outcomes." (Petit JH, Int J Radiat Oncol Biol Phys. 2003 Jul 15;56(4):1147-53.)
 * Retrospective. 96/112 patients. RT dose 75 Gy (70-80 Gy). Questionnaire containing BNI and McGill pain scales. Median f/u 30 months
 * Pain relief: 77% after median 3 weeks (0-24 weeks), 66% had decrease in meds use. Response associated with lack of prior surgical treatment and <50 month pain duration.
 * QOL: If sustained pain relief - 100% improvement in QOL and 100% belief in success, if temporary pain relief - 80% improvement in QOL and 65% belief in success
 * Side effects: 7% trigeminal dysfunction, 3% bothersome


 * Georgia, 2006 PMID 16825804 -- "Outcome of Patients Undergoing Gamma Knife Stereotactic Radiosurgery for Medically Refractory Idiopathic Trigeminal Neuralgia: Medical College of Georgia's Experience." (Fountas KN, Stereotact Funct Neurosurg. 2006;84(2-3):88-96.)
 * Retrospective. 77 patients.
 * Pain control: no prior surgery 92% vs. prior surgery 84%, excellent outcome at 3 years 54% vs. 12%, good outcome 19% vs. 32%
 * Side effects: facial numbness


 * San Diego Gamma Knife Center, 2006 NSA Abstract -- "Dose response of Gamma Knife surgery for trigeminal neuralgia and high-dose salvage of failed Gamma Knife surgery" (Ott K, Neurosurgical Society of America Abstract, 2006)
 * Retrospective. 263 patients treated, 26 retreated. RT dose range 26-140 Gy. Average f/u 32 months
 * Pain control: Typical TN 85% excellent/good, Atypical TN 46% excellent/good. Dose response present, now use 97 Gy for both treatment and retreatment.
 * Side effects: >50% facial numbness, usually transient. Better pain control results
 * Retreatment: Same benefit. Comparable facial numbness, better response. Some with fair/poor/no response initially had excellent response on retreatment


 * Washington University, 2005 PMID 16205107 -- "Gamma knife radiosurgery for trigeminal neuralgia: the Washington University initial experience." (Drzymala RE, Stereotact Funct Neurosurg. 2005;83(4):148-52.)
 * Retrospective. 73 patients. RT 76-87 Gy.
 * Outcome (naive vs. prior surgery): complete pain relief 59% vs. 33%; >=50% pain reduction 25% vs. 28%, no relief 16% vs. 28%
 * Side effects: 15% numbness/paresthesias, 2% bothersome


 * USC, 2005 1997-2003 PMID 15918946 -- "Gamma knife radiosurgery for trigeminal neuralgia." (NcNatt SA, Neurosurgery. 2005 Jun;56(6):1295-301; discussion 1301-3.)
 * Retrospective. 49 patients. RT 40 Gy to 50% isodose, max 80 gy. 16% prior GR, 16% prior MVD. Median f/u 49 months
 * Pain relief 61% (BNI I-III), including 32% complete pain relief. Recurrence 29%, median time 9.6 months
 * Side effects: 29% mild/moderate facial numbness, 18% mild dysesthesias


 * Louisiana State
 * 2005 PMID 15913284 2000-2004 -- "Assessment of pain control, quality of life, and predictors of success after gamma knife surgery for the treatment of trigeminal neuralgia." (Jawahar A, Neurosurg Focus. 2005 May 15;18(5):E8.)
 * Retrospective. 52/81 patients treated responded to questionnaire. Median f/u 16.5 months
 * Pain control: 42% complete, 27% partial, 31% failed. Recurrence 13%. Overall satisfaction 80%
 * 2004 PMID 15165787 -- "Gamma knife radiosurgery for trigeminal neuralgia: a study of predictors of success, efficacy, safety, and outcome at LSUHSC." (Shaya M, Surg Neurol. 2004 Jun;61(6):529-34; discussion 534-5.)
 * Retrospective. 41 patients. RT 70-90 Gy. Median f/u 14 months
 * Pain control: 40% excellent, 30% good, 30% failed. Vascular compression on MRI did not impact outcome. Improvement with dose >=80 Gy
 * 2002 PMID 11892881 -- "First 100 cases of gamma knife radiosurgery in Louisiana: analysis of demographics and early results." (Jawahar A, J La State Med Soc. 2002 Jan-Feb;154(1):31-6.)
 * GK commissioned 01/2000. Mets main indication, TN an indication


 * Rosewell Park, 2005 PMID 15796377 -- "Stereotactic gamma knife surgery for trigeminal neuralgia: detailed analysis of treatment response." (Tawk RG, J Neurosurg. 2005 Mar;102(3):442-9.)
 * Retrospective. 38 patients. RT to 35, 40, or 45 Gy to 50% isodose via 4-mm. Median follow-up 24 months
 * Pain relief (@24 months): 21% excellent/good, 3% fair, 50% poor, 26% still in f/u
 * Side effects: 37% facial numbness, dose related. But, higher pain relief in patients with facial numbness
 * No effect of dose (70Gy vs. 90Gy)


 * Virginia, 2005 1996-2003 PMID 15796376 -- "Gamma knife surgery for trigeminal neuralgia: outcomes and prognostic factors." (Sheehan J, J Neurosurg. 2005 Mar;102(3):434-41.)
 * Retrospective. 151 patients (14 repeats, 1 tripeat). RT 50-90 Gy, target 2-4mm anterior to entry into pons. Median f/u 19 months
 * Pain relief: 47% pain free/no meds at 1 year, 34% at 3 years. 90% some improvement at 1 year, 70% at 3 years. Mean time-to-relief 24 days (1,180). Relapse: 27% at median 12 months (2,34)
 * Side effects: 9% facial numbness, correlated with undergoing >1 GK


 * Prague (Czech)
 * 2005 PMID 15662776 -- "Treatment of essential trigeminal neuralgia with gamma knife surgery." (Urgosik D, J Neurosurg. 2005 Jan;102 Suppl:29-33.)
 * Retrospective. 107 patients. RT 70-80 Gy. Median f/u 60 months. Repeat in 19 patients, same dose.
 * Pain relief: Initial 96% (complete 80%). Median time to improvement 3 months (1 day, 13 months). Recurrence 25%, median interval 36 months (6, 94).
 * Retreatment: 19 patients (17%), initial pain relief 89% (complete 58%). Relapse 1 patient thus far
 * Side effects: Hypesthesia 20% after first GK, 32% after second GK. Median interval 35 months (3, 94) after first GK, 21 months (1, 72) after second
 * 2000 PMID 11143238 1995-1999 -- "Treatment of postherpetic trigeminal neuralgia with the gamma knife." (Urgosik D, J Neurosurg. 2000 Dec;93 Suppl 3:165-8.)
 * Retrospective. 16 patients treated for postherpetic TN. RT 70-80 Gy. Mean f/u 33 months
 * Pain relief: Success (excellent, very good, good) in 44%, failure in 56%. Pain relief after median 1 month
 * Side effects: none
 * 1998 PMID 9782252 1995-1996 -- "Gamma knife treatment of trigeminal neuralgia: clinical and electrophysiological study." (Urgosik D, Stereotact Funct Neurosurg. 1998 Oct;70 Suppl 1:200-9.)
 * Retrospective. 49 patients, 31 essential TN, 7 MS-TN, 3 atypical TN, 8 postherpetic TN
 * Pain control (excellent, very good, good): EN 77%, MSTN 43%, ATN 33%, PTN 38%. Median relief 2 months
 * Side effects: hypesthesia 6%, 11% slight electrophysiological changes


 * Columbia
 * 2004 PMID 15137604 -- "Gamma knife surgery with a dose of 75 to 76.8 Gray for trigeminal neuralgia." (Brisman R, J Neurosurg. 2004 May;100(5):848-54.)
 * Retrospective. 293 patients. Median f/u 1.9 years
 * Final pain relief: 22% complete, 30% mostly (>90%, minor meds), 92% good (>50%). Recurrence requiring 2 GKS in 70 patients (24%)
 * Side effects: dysesthesia >5/10 in 3%
 * Atypical TN less likely to attain pain relief
 * 2000 PMID 11143236 -- "Gamma knife radiosurgery for primary management for trigeminal neuralgia." (Brisman R, J Neurosurg. 2000 Dec;93 Suppl 3:159-61.)
 * Retrospective. 82 patients with primary GKS treatment vs. 90 patients with GKS as a retreatment. RT dose 75 Gy
 * Pain control: excellent or good result more likely in primary GKS (p=0.058), and not in MS-associated TN (SS). Number and type of procedures NS.


 * Northwest Hospital (Seattle)
 * 2003 ASTRO Abstract -- "Gamma Knife Radiosurgery for Treatment of Trigeminal Neuralgia" (Mehta V, Abstract 21, 2003)
 * Retrospective. 250 patients (no MS-TN, or secondary TN). RT dose 76 Gy, 87 Gy, or 98 Gy. Median f/u 2.4 years
 * Pain control: 6 months - 42% excellent, 33% good. Last f/u - 50% excellent, 14% good. Recurrence in 18%, mean time-to-recurrence 1.8 years (0.5 - 6). At 12 months - 76 Gy 70%, 87 Gy 86%, 98 Gy 86% (trend, but NS)
 * 2000 Abstract 1991-1999 -- "Gamma Knife radiosurgery for treatment of trigeminal neuralgia: long term results" (Young RF, 3rd TN Conference, 2000)
 * Retrospective. 435 patients. RT 76-98 Gy. Median f/u 51 months. 51 patients retreated. Joint with Good Samaritan data??
 * Pain control: 6 months - 60% excellent, 30% good (some meds). Last f/u - 78% excellent/good. Including retreatment, 65% excellent, 20% good
 * Retreatment: success 80%
 * Side effect: 16% facial numbness
 * 1998 PMID 9782251 -- "Gamma knife radiosurgery for the treatment of trigeminal neuralgia." (Young RF, Stereotact Funct Neurosurg. 1998 Oct;70 Suppl 1:192-9.)
 * Retrospective. 110 patients. RT dose 70-80 Gy. Mean f/u 20 months
 * Pain control: Initial relief 95%, 3% recurrence. Atypical TN 88%, 19% recurrence
 * Side effects: 3% sensory
 * 1997 PMID 9065534 -- "Gamma Knife radiosurgery for treatment of trigeminal neuralgia: idiopathic and tumor related." (Young RF, Neurology. 1997 Mar;48(3):608-14.)
 * Retrospective. 60 patients. RT 70 Gy. Mean f/u 16.3 months
 * Pain control: 75% excellent, 14% good. Better outcome if no prior surgery. Recurrence 7%. At last follow-up 80% excellent or good result
 * Side effects: 1 patient facial numbness


 * Baylor, 2002 PMID 12677104 -- "Gamma knife radiosurgery for treatment of trigeminal neuralgia in multiple sclerosis patients." (Huang E, Stereotact Funct Neurosurg. 2002;79(1):44-50.)
 * Retrospective. 7 patients with MS-associated TN. RT 80-90 Gy. Median f/u 28 months
 * Pain relief: 100% excellent response. Time-to-response 1 day - 8 months. 1/7 recurrence 24 months after treatment
 * Side effects: 4/7 patients persistent numbness in V2 and V3.


 * Arizona Onc Services / Barrow Neurologic Institute
 * 2002 PMID 12507090 -- "Gamma knife radiosurgery for trigeminal neuralgia associated with multiple sclerosis." (Rogers CL, J Neurosurg. 2002 Dec;97(5 Suppl):529-32.) Links
 * Retrospective. 15 patients with MS-associated TN. RT 70-90 Gy. Median f/u 17 months
 * Pain relief: 80% some pain relief. Time-to-response 56 days (1-157 days).
 * Retreatment: 5/15 patients, RT dose 48 Gy, same target. All improved
 * Side effects: 2/15 delayed facial hypesthesias after 1st GKS, 2/5 after 2nd GKS. None bothersome. All with hypesthesias had complete pain relief
 * 2000 PMID 10863073 1997-99 &mdash; "Gamma knife radiosurgery for trigeminal neuralgia: the initial experience of The Barrow Neurological Institute." Rogers CL et al. Int J Radiat Oncol Biol Phys. 2000 Jul 1;47(4):1013-9.
 * 54 pts treated with follow-up of at least 3 months. First 41 treated with 35 Gy to 50% isodose, then 40 Gy for the last 14 pts. Single 4mm shot.
 * Median onset to pain relief, 15 days; to maximal relief, 63 days. 41% able to stop all medications.


 * Mayo
 * 2002 PMID 12186463 -- "Stereotactic radiosurgery for idiopathic trigeminal neuralgia." (Pollock BE, J Neurosurg. 2002 Aug;97(2):347-53.)
 * Retrospective. 117 patients. Median f/u 26 months
 * Pain control: excellent 57% at 1 year, 55% at 3 years (actuarial). Greater for previously untreated patients.
 * Side effects: trigeminal dysfunction 37%, bothersome 12%. Strong correlation between facial sensory loss and pain relief
 * 2000 PMID 10719853 -- "Stereotactic radiosurgery for tumor-related trigeminal pain." (Pollock BE, Neurosurgery. 2000 Mar;46(3):576-82; discussion 582-3.)
 * Retrospective. 24 patients with cranial base tumors and TN (9) or painful trigeminal neuropathy (15). Radiologic target was tumor. Median f/u 45 months
 * Pain control: 50% initially pain free, 46% significan improvement. 3/24 recurrent pain related to tumor progression
 * 1999 PMID 9987527 -- "The Mayo Clinic gamma knife experience: indications and initial results." (Pollock BE, Mayo Clin Proc. 1999 Jan;74(1):5-13.) Links
 * Retrospective. 20 patients with TN, 70% pain free after SRS
 * Comment in Mayo Clin Proc. 1999 Jan;74(1):101-3.


 * Seoul (Korea)
 * 2002 PMID 12507091 -- "Unusual causes of trigeminal neuralgia treated by gamma knife radiosurgery. Report of two cases." (Chang JW, J Neurosurg. 2002 Dec;97(5 Suppl):533-5.)
 * Case report. TN caused by lesions along trigeminal nerve within pons, adjacent to 4th ventricle. Postulated old viral neuritis
 * Treated with GKS. Results encouraging so far.
 * 2000 PMID 11143233 1992-1995 -- "Gamma knife radiosurgery for idiopathic and secondary trigeminal neuralgia." (Chang JW, J Neurosurg. 2000 Dec;93 Suppl 3:147-51.)
 * Retrospective. 15 patients with idiopathic TN and 38 patients with secondary TN
 * Idiopathic TN: pain control 87%, 2/15 mild sensory change
 * Secondary TN: pain control 67%
 * 1999 PMID 10681688 1991-1998 -- "The effects of stereotactic radiosurgery on secondary facial pain." (Chang JW, Stereotact Funct Neurosurg. 1999;72 Suppl 1:29-37.)
 * Retrospective. 27 patients with secondary TN. RT mean dose 26.4 Gy to 45-90% isodose. Mean f/u 32 months
 * Pain control: 86% initial relief, but 50% recurred. Less responsive to SRS than idiopathic TN


 * Alabama, 2002 1995-2001 ASTRO Abstract -- "Radiosurgery for Trigeminal Neuralgia" (Spencer SA, Abstract 2063, 2002)
 * Retrospective. 163 facial pain, 104/113 typical TN. RT 35 Gy to 50% isodose line (36 patients), 40 Gy to 50% isodose line (68 patients). Min f/u 6 months, median f/u 28 months.
 * Pain control: 72% excellent or good. 52% 35 Gy vs. 81% 40 Gy
 * Side effects: 16% paresthesias. 2% 35 Gy vs. 14% 40 Gy. Bothersome 4%


 * Chiba, 2002 (Japan) PMID 12507089 -- "Gamma knife radiosurgery for trigeminal neuralgia: the dry-eye complication." (Matsuda S, J Neurosurg. 2002 Dec;97(5 Suppl):525-8.)
 * Retrospective. 33/41 patients treated with GKS to 80 Gy, 4-mm collimator, single isocenter. Mean f/u 13 months
 * Pain control at last follow up: 49% excellent, 27%. Recurrence 7%
 * Side effects: 17% facial numbness. 3 patients reported "dry eye", with diminution/absence of corneal reflex. No other abnormalities.


 * Marseille (France)
 * 2001 PMID 11780888 1992-1997 -- "Long-term outcome after gamma knife surgery for secondary trigeminal neuralgia." (Regis J, J Neurosurg. 2001 Aug;95(2):199-205.)
 * Secondary TN. Median f/u 55 months. Treatment groups as below (Regis, 1998)
 * Neuropathic component poorly sensitive to SRS.
 * 2001 Abstract Régis J, Billet F, Hayashi M: Plexus triangularis gamma knife radiosurgery for trigeminal neuralgia: Results of a 110 patients prospective controlled study. Presented at Symposium on Vascular Interventions, 5th International Stereotactic Radiosurgery Society Congress, Las Vegas, NV, June 10–13, 2001.
 * Goal median dose 90 Gy, but due to blocking brainstem actual average 85 Gy
 * 1999 PMID 10099103 -- "Radiosurgery for trigeminal neuralgia and epilepsy." (Regis J, Neurosurg Clin N Am. 1999 Apr;10(2):359-77.)
 * Initial experience with higher doses to 90 Gy
 * Pain control: 90% instead of 65% with original lower doses
 * 1998 PMID 9782253 -- "Effect of gamma knife on secondary trigeminal neuralgia." (Regis J, Stereotact Funct Neurosurg. 1998 Oct;70 Suppl 1:210-7.)
 * Retrospective. 53 patients with secondary TN. Four groups (I - essential TN, II - secondary TN with CNV visualized, III - secondary TN with CNV not visualized, IV - goal of tumor control). Groups I/II treated to 70-90 Gy, Groups III/IV treated to 20-40 Gy. Mean f/u 32 months
 * Pain relief: short term 74% excellent, 18% good
 * Side effects: 4% facial hypesthesia, 1 patient motor fasciculation


 * Pittsburgh
 * 2001 PMID 11803302 -- "Stereotactic radiosurgery for the treatment of trigeminal neuralgia." (Kondziolka D, Clin J Pain. 2002 Jan-Feb;18(1):42-7.) and PMID 11147887 -- "Clinical outcomes after stereotactic radiosurgery for idiopathic trigeminal neuralgia." (Maesawa S, J Neurosurg. 2001 Jan;94(1):14-20.)
 * Retrospective. 220 patients. RT dose median 80 Gy (60-90 Gy). 16% atypical TN. Median 2 years
 * Pain control: complete or partial in 86% at 1 year, 56% at 5 years. Complete relief in 65% (6 months), 70% (1 year), 75% (2.8 years). Atypical pain had lower rate of pain relief. No prior surgery higher rate of pain relief
 * Side effects: 10%
 * 1998 PMID 9782250 -- "Gamma knife radiosurgery as the first surgery for trigeminal neuralgia." (Kondziolka D, Stereotact Funct Neurosurg. 1998 Oct;70 Suppl 1:187-91.)
 * Retrospective. 23 patients. RT 70 Gy (14 patients) or 80 Gy (9 patients). Mean f/u 12 months
 * Pain control: Excellent 74%, good 22%
 * Side effects: None
 * 1998 PMID 9865796 -- "Gamma knife radiosurgery for trigeminal neuralgia: results and expectations." (Kondziolka D, Arch Neurol. 1998 Dec;55(12):1524-9.)
 * Retrospective. 106 patients. RT dose 70-90 Gy. Median f/u 18 months
 * Pain control: Initial 60% excellent, 17% good. Last follow-up 77% excellent + good. Dose, age, prior surgery, sensory loss didn't correlate with outcome. 10% recurrence
 * Side effects: paresthesias 10%
 * 1996 PMID 9032878 -- "Trigeminal neuralgia radiosurgery: the University of Pittsburgh experience." (Kondziolka D, Stereotact Funct Neurosurg. 1996;66 Suppl 1:343-8.)
 * Retrospective. 51 patients with typical TN. RT dose 60-90 Gy. 86% prior surgery. Mean f/u 10 months
 * Pain control: Initial 86% response. Last follow-up 37% excellent, 41% good, 21% failed
 * RT dose >=70 Gy associated with significantly greater chance for complete pain relief


 * Tianjin, 2001 (China) 1996-1999 PMID 12007276 -- "Stereotactic radiosurgery for primary trigeminal neuralgia using the Leksell Gamma unit." (Zheng LG, Stereotact Funct Neurosurg. 2001;76(1):29-35.)
 * Retrospective. 80 patients. RT dose mean 75.6 Gy (70-90 Gy). Follow-up 24 months
 * Pain control: excellent 52%, good 31%, fair 10%, fail 6%. Mean time to improvement 22 days (1-120 days). Recurrence 10% in 5-26 months later
 * Retreatment: 12 patients (7 recurrent, 5 failures). RT dose mean 74.2 Gy (70-80 Gy). Mean f/u 18 months, 9/12 excellent result, 2/12 good result, 1 failed. Mean time to improvement 15 days (1-120)
 * Side effects: 11% facial numbness


 * Yale, 2001 1998-1999 ASTRO Abstract -- "Gamma Knife Radiosurgery for the Treatment of Trigeminal Neuralgia: Early Results of the Yale Experience" (Kim DH, Abstract 107, 2001)
 * Retrospective. 54 cases, idiopathic or MS-TN. RT dose 80 Gy. Median f/u 1.1 years
 * Pain control: 98% response, 85% decreased meds. Recurrence 32% at 60 weeks actuarial, 24% if CR
 * Side effects: 13% hypesthesia, 4% decreased corneal sensation, 4% paresthesias


 * Kentucky, 2000 PMID 11143234 -- "Gamma knife radiosurgery using 90 Gy for trigeminal neuralgia." (Nicol B, J Neurosurg. 2000 Dec;93 Suppl 3:152-4.)
 * Retrospective. 42 patients treated to 90 Gy. Median f/u 14 months
 * Pain control: 74% complete, 21% good.
 * Side effects: paresthesia 17%, dysgeusia 10%


 * Cleveland Clinic, 2000 ASTRO Abstract 1997-1999 "Results of gamma knife radiosurgery for trigeminal neuralgia" (Suh JH, Abstract 264, 2000)
 * Retrospective. 55/95 patients, phone survey. 22% TN-MS. RT dose 75 Gy
 * Pain control: 65% BNI I/II, 27% BNI III
 * Side effects: mild numbness 11%


 * Mumbai, 1999 (India) PMID 10901930 -- "Gamma-knife radiosurgery for trigeminal neuralgia." (Kannan V, Australas Radiol. 1999 Aug;43(3):339-41.)
 * Retrospective. 7 patient treated. RT 70-80 Gy. Follow up 5-16 months
 * Pain control: complete 4/7, partial 2/7. No side effects


 * UCLA, 1997 PMID 9018707 -- "Leksell Gamma Knife treatment of tic douloureux." (Rand RW, Neurosurg Clin N Am. 1997 Jan;8(1):75-8.)
 * Retrospective. 12 patients. F/u 3-4 years
 * Pain control: 8/12 improvement or complete relief.
 * Side effects: 1 radionecrosis in medial temporal lobe


 * Good Samaritan LA, 1996 1991-1995 ASTRO Abstract "Intractable Trigeminal Neuralgia: A Single Institution Experience in 26 Patients Treated With Stereotactic Gamma Knife Radiosurgery" (Rufus JM, Abstract 71, 1996)
 * Retrospective. 26 patients. RT 64.3 - 70 Gy, 1 patients 120 Gy. Median f/u 19 months
 * Pain control: Last follow-up - 42% excellent, 42% good (>50% reduction). Dose response: <70 Gy 25% CR, 70 Gy 57% CR
 * Side effects: 8% (1 patient numbness, 1 patient temporal lobe edema, resolved after decadron)


 * Multi-institutional, 1996 PMID 8847587 -- "Stereotactic radiosurgery for trigeminal neuralgia: a multiinstitutional study using the gamma unit." (Kondziolka D, J Neurosurg. 1996 Jun;84(6):940-5.)
 * 5 institutions (Pittsburgh, Northwest Hospital, Good Samaritan Hospital, Marseille, Brown). 50 patients. RT dose 60-90 Gy. Median f/u 18 months
 * Pain control: 58% excellent, 36% good (50-90%), 6% failure. Time to pain relief 1 month (1 day - 6.7 months). 6% recurrence. At 2 years 54% pain-free, 88% good relief
 * RT: dose >=70 Gy with significantly greater chance of complete relief (72% vs. 9%)
 * Side effects: 6% facial paresthesias


 * Marseille, 1995 (France) PMID 8584826 -- "Effect of the Gamma Knife on trigeminal neuralgia." (Regis J, Stereotact Funct Neurosurg. 1995;64 Suppl 1:182-92.)
 * Initial report. 20 patients with TN, 11 with goal of pain relief, 9 with tumor control
 * Appear to have rapid clinical improvement and great benefit


 * Karolinksa, 1971 (Sweden) PMID 4948331 -- "Sterotaxic radiosurgery in trigeminal neuralgia." (Leksell L, Acta Chir Scand. 1971;137(4):311-4.)