Gamma Knife South Africa

Disclaimer

Professional overview

for trigeminal neuralgia

Key takeouts

It should be noted that Gamma Knife radiosurgery is only recommended in patients who still have pain after being given the highest dose of medication that they can tolerate. After Gamma Knife surgery, some patients will start to experience breakthrough pain that can be controlled with medicines whilst others will need a second Gamma Knife surgery.
Probability of freedom from pain after Gamma Knife stereotactic radiosurgery (GKSR)
Following GKSR, 93.8 %5 of patients were pain free with or without medication. Some patients will need medication. Most patients (median) had pain relief 15 days after surgery. After the first month, 54.6 % of patients were pain free, climbing to 89.2 % before peaking at 93.8 % at 6 months.
Sensory dysfunction

No patients developed an early complication after GKSR. However, during the first 5 years after radiosurgery, 19.8 % of patients developed new sensory dysfunction (paresthesias or facial sensory loss), with most experiencing this at 12 months. After peaking at 20.8 % at 7 years, the rate remained stable until 14 years. Sensory dysfunction was mild in 18.8 % of patients, somewhat bothersome in 0.8 %, and very bothersome in 0.8 %.

Quality of life
Quality of life is an important measure that puts all the clinical outcomes into a meaningful measure about how the treatment has helped the patient. The majority of the patients considered that their quality of life improved after radiosurgery and that the sensory dysfunction, when present, was a good trade-off for pain relief. Only 2.3 % of patients reported that their quality of life was worse, and that sensory dysfunction was not a good trade-off.
Probability of pain relief without medication

Some patients will need to take lower doses of medication to control their pain.

After 1 year, 85.9 % were pain free without medication dropping to 45.3 % at 10 years. The probability of achieving and maintaining pain relief without medication at 0.5, 1, 2, 3, 5, 7, 10, 12 and 14 years was 93.4, 85.9, 78.6, 71.8, 64.9, 59.7, 45.3, 40.7 and 33.9 %, respectively.

The probability of remaining pain free was higher, with a shorter delay between trigeminal neuralgia pain onset and radiosurgery [p = 0.04, hazard ratio (HR) = 1, 95 % confidence interval (CI) = 0.99–1] but was not influenced by the development of post radiosurgery hypoesthesia (p = 0.88) or the existence of a neurovascular conflict on MRI (p = 0.38), with the same applying to plugging (p = 0.14). Furthermore, an earlier initial response predicted a better long-term benefit (p < 0.05).

Probability of pain relief not requiring new surgery (minor recurrence)
If there is breakthrough pain not controlled with a combination of medication after surgery, then it is possible to undergo a second GKSR or one of the alternative treatments available. Just over 90 % of patients will not need another surgery within the first year, but this drops to 67.7 % at 10 years, remaining at this level until 14 years.