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. 2025 Aug 6;17(8):e89485.
doi: 10.7759/cureus.89485. eCollection 2025 Aug.

Outcomes, Predictors of Retreatment, and Complications After Repeat Gamma Knife Radiosurgery for Trigeminal Neuralgia: A Single-Center Retrospective Cohort Study

Biljana Seha  1 , Vojislav Bogosavljevic  2 , Danica Grujicic  2 , Vuk Djulejic  3 , Mihailo Milićević  1 , Rosanda Ilic  1 , Koca Cicarevic  1 , Marija Jovanovic  4 , Slobodan Kapor  5
Affiliations

Outcomes, Predictors of Retreatment, and Complications After Repeat Gamma Knife Radiosurgery for Trigeminal Neuralgia: A Single-Center Retrospective Cohort Study

Biljana Seha et al. Cureus. .

Abstract

Objective: This study was conducted to evaluate the outcomes of repeat Gamma Knife surgery (GKS) in patients with recurrent trigeminal neuralgia (TN), identify predictors for retreatment, and characterize associated complications.

Methods: Among 198 patients initially treated with GKS for TN, 34 (17.2%) underwent a second procedure due to recurrent or persistent pain. After applying the eligibility criteria, 25 patients were analyzed. Factors associated with retreatment were assessed, and complications and pain relief outcomes following repeat GKS were evaluated.

Results: Prior microvascular decompression (MVD) and lower initial radiation dose were significantly associated with need for retreatment (p < 0.001 and p = 0.014, respectively). Neurovascular conflict and prior rhizotomy were not statistically significant predictors. Facial hypoesthesia was the most common complication after repeat GKS (64%). Repeat treatment yielded moderate pain relief in most patients, but durable long-term benefit was limited, consistent with literature reporting 40-60% efficacy.

Conclusions: Repeat GKS is a valuable option for recurrent TN but presents a risk of sensory complications. Prior MVD and lower initial dose are important predictors of retreatment necessity, guiding individualized patient counseling and treatment planning.

Keywords: gks; neuro radiology; stereotactic and functional neurosurgery; trigeminal nerve; trigeminal neuralgia.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. University of Belgrade - Faculty of Medicine issued approval 9700/12 –БШ, dated December 22, 2020. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Gamma Knife surgery treatment and retreatment for left sided trigeminal neuralgia
Figure 2
Figure 2. Incidence of complications after repeat Gamma Knife surgery
See this image and copyright information in PMC

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