The Effectiveness of Gamma Knife Surgery in the Treatment of Trigeminal Neuralgia : A Systematic Review

Abstract

Introduction: Gamma knife surgery is one of the stereotactic surgery which recently used in the treatment of trigeminal neuralgia due to its minimally invasive nature. The short-term effectiveness of gamma knife surgery in a reduction of pain episodes among patients with trigeminal neuralgia are reported by several studies. However, few studies elaborated the long-term effectiveness of gamma knife surgery. Objective: This review aimed at evaluating the effectiveness of gamma knife surgery by reviewing of pain relief rates and recurrence rates reported by the included studies. Methods: The electronic search was conducted in Medline, EmBase and Science direct databases using the key words of (Gamma knife surgery AND trigeminal neuralgia). The search of the literature, after exclusion of irrelevant, duplicated and review studies revealed 8 studies met the inclusion criteria. The data extraction conducted using data extraction sheet regarding characteristics such as duration of symptoms, number of trigeminal divisions involved, lack of sensation or surgery before surgery, anatomical results in the operation, the rate of pain relief and pain recurrence rate. Results: The history of surgery and medications before gamma knife radio surgery was assessed by included studies. It was found that only one study used gamma knife surgery as their first treatment of choice with no prior surgery. The pain relief rate ranged from 73.8% to 96% while pain recurrence rate, which reported in four included studies ranged from 2% to 26.3%. Conclusions: The gamma knife surgery was not the first surgical choice of treatment in most of the studies. The reported pain relief rates associated with this new technique were generally high while pain recurrence rates were low. As the worst reported scenario found about a quarter of patients complained of pain recurrence following gamma knife surgery.