Gamma knife surgery for idiopathic trigeminal neuralgia targeting the neurovascular contact zone: the Cairo International medical centre initial experience

ABSTRACT

Gamma knife radiosurgery is being increasingly performed in the management of patients with medically unresponsive idiopathic trigeminal neuralgia [ITN]. The purpose of this study is to assess initial outcomes in patients treated with gamma knife surgery [GKS] for ITN unresponsive to pharmacologic treatment or previous invasive procedures. Eighteen patients with ITN unresponsive to pharmacologic treatment and/or previous invasive procedures underwent stereotactic GKS targeting the neurovascular contact [NVC] zone in Gamma Knife Centre, International Medical Centre in Cairo, Egypt. Follow-up period ranged between 6 - 28 months. Six patients categorized their pain as group I excellent response, 6 patients as group II good response, 3 patients as group Ill fair response and 4 patients as group IV poor response. The treatment was successful in 15 patients [groups I and II had complete relief and group Ill had partial relief], 83% of the studied cases. The time of pain relief ranged between 1 -3 months. All the 18 patients in our study had NVC that was proven and detected in the 3D-T2-MRI sequence and was the gamma knife target point for treatment. Side effects seem to be limited to sensory impairment that is usually mild in intensity and occurred in only 3 patients in our study. Gamma knife surgery is a safe and effective treatment for ITN unresponsive to pharmacologic treatment and/or previous invasive procedures