Gamma knife radiosurgery for trigeminal neuralgia: is anterior selective targeting a reasonable alternative?
BRITISH JOURNAL OF NEUROSURGERY, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Basım Tarihi: 2026
- Doi Numarası: 10.1080/02688697.2026.2658093
- Dergi Adı: BRITISH JOURNAL OF NEUROSURGERY
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, MEDLINE, Violence & Abuse Abstracts, Academic Search Ultimate (EBSCO), Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest)
- Gazi Üniversitesi Adresli: Evet
Özet
Purpose: To compare clinical outcomes and complication profiles of the anterior selective targeting (AST), which selectively targets the V2-V3 preganglionic region to minimize V1 exposure, versus dorsal root entry zone targeting (DREZ) in trigeminal neuralgia (TN). Material and Methods: We retrospectively analyzed 34 medically refractory TN patients treated with Gamma Knife radiosurgery (GKRS) at the Gamma Knife Radiosurgery Centre of Gazi University (January 2022-April 2023). Target selection was non-randomized and based on dermatomal symptoms and MRI anatomy: AST was used in patients without V1 involvement when trigeminal divisions could be confidently separated within Meckel's cave on 1.5-T MRI; otherwise, DREZ targeting was performed. GKRS was delivered using a single 4-mm collimator shot with 43 Gy prescribed to the 50% isodose line. At 12 months, outcomes included changes in Visual Analog Scale (VAS) and Barrow Neurological Institute (BNI) pain scores, BNI facial numbness score, corneal reflex status, medication changes, pain-free interval, subjective pain assessment, patient satisfaction, and beam-on time. Results: Symptom duration was longer in AST group (p = 0.031). Both groups showed significant reductions in VAS and BNI after GKRS (p < 0.05). Delta VAS and Delta BNI were slightly greater in the DREZ group (p = 0.039 and p = 0.045). No significant between-group differences were observed in medication use, pain-free interval, subjective pain assessment, satisfaction, facial numbness and corneal reflex status. Two DREZ patients had decreased corneal reflex. Beam-on time was shorter with AST (median 64.8 vs. 86.1 minutes; p < 0.001). Conclusion: In selected TN patients without V1 involvement, AST provides effective pain control with comparable 12-month outcomes to DREZ and shorter beam-on time. Given its relative distance from the brainstem and reduced V1 inclusion, AST may be considered for initial or repeat GKRS in selected cases.