Gamma Knife Surgrey: The Best (Radical) Option?

In October 2005, ScienceDaily published an article concerning research performed at the Comprehensive Cancer Center at Wake Forest University Baptist Medical. The article, titled "Gamma Knife Effective in Treating Trigeminal Neuralgia," states that Gamma Knife Stereotactic Radiosurgery (GKRS) is a safe, effective alternative treatment for patients suffering from neuralgia. Typical side effects of surgical treatments can include facial numbness, as well as problems with infection or anesthesia because they require incisions. GKR, on the other hand, is a non-invasive procedure that relies on small beams of radiation to target the problematic nerve. ScienceDaily reports that, in the Comprehensive Cancer Center research: "Ninety percent of patients with trigeminal neuralgia had significant pain relief within an average of four weeks. Approximately one-third of these patients did experience some degree of facial numbness, but 80 percent reported a significant improvement in their quality of life since the numbness was much more tolerable than the facial pain."

Gamma-Knife Radiosurgery works by focusing 201 beams of cobalt-60 radiation on a specific region in the brain; for Trigeminal Neuralgia patients, this target area is the trigeminal nerve, at the point where it exits the brain. The treatment does not require general anesthesia, and the patient stays in the hospital for less than five hours. However, because it deals with radiation, risk of radiation injury increases with the amount of tissue receiving treatment. Radiation injury can cause latent swelling, which usually resolves itself but can also be controlled with corticosteroid medications for persistent brain swelling.

One positive aspect of GKR is that most patients are eligible for the surgery; because it is non-invasive, it is a possible treatment for the elderly, as well as patients suffering other medical conditions. However, because the treatment is so recently developed (most cases of TN have been treated within the last five years) that there is not much information on long term effects, although no major complications have been reported to date.

Overall, patients report a drastic reduction of pain (80-90%), with results similar to that of microvascular decompression and radiofrequency lesioning (the advantage to GKR, of course, is the fact that it is a non-invasive, outpatient procedure). The major disadvantage to GKR is its delayed effect: it can take 4-6 weeks for a patient to notice a difference in pain.