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Gamma Knife Radiosurgery in the Treatment of Tumor-Related Facial Pain

Squire S.E.a · Chan M.D.a · Furr R.M.c · Lowell D.A.a · Tatter S.B.b · Ellis T.L.b · Bourland J.D.a · deGuzman A.F.a · Munley M.T.a · Ekstrand K.E.a · Shaw E.G.a · McMullen K.P.a
Departments of aRadiation Oncology, bNeurosurgery and cPsychology, Wake Forest University, Winston-Salem, N.C., USA Stereotact Funct Neurosurg 2012;90:145–150 (DOI:10.1159/000335873)


Background: Intracranial neoplasms can cause pain similar to trigeminal neuralgia. Literature regarding radiosurgery for this is limited. We present a retrospective review of patients with tumor-related facial pain from benign lesions treated with gamma knife radiosurgery (GKRS) at Wake Forest University. Objectives: The primary objectives were to determine long-term pain relief and predictive factors for pain alleviation. Methods: We reviewed 515 patients treated with GKRS for benign meningioma, vestibular schwannoma or trigeminal schwannoma between August 1999 and August 2010. Twenty-one eligible patients had tumor-related facial pain prior to GKRS. The median marginal tumor dose was 12 Gy. Long-term pain relief data were obtained by chart review and telephone interview. Results: The median follow-up for symptom evaluation was 3.8 years. Seventeen of 21 patients (81%) experienced a Barrow Neurological Institute (BNI) score of I–III at 6 months following GKRS. Kaplan-Meier estimates of freedom from BNI IV–V relapse were 66% at 1 year and 53% at 2 years. No pain relapses occurred after 2 years. Conclusion: GKRS of benign lesions is a noninvasive option for patients with tumor-related facial pain. Pain relief is modest, with the majority of pain relapses occurring within 2 years and approximately one half of patients maintaining relief beyond 2 years.


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