Repeat LINAC Radiosurgery from Previously Treated Gamma Knife Radiosurgery on Medically Refractory Classical Trigeminal Neuralgia

Trigeminal neuralgia (TN) is a debilitating neurological disorder characterized by sudden, severe facial pain along the distribution of the trigeminal nerve. It may significantly affect a patient’s quality of life. Stereotactic radiosurgery (SRS) is a non-invasive therapeutic option for managing TN, providing targeted precision and minimal side effects. The long-term benefits of SRS are noteworthy, as pain relief often persists for several years after the procedure. The authors aim to present a rare case of a reirradiation of a recurrent trigeminal neuralgia case. This is a case of a 74-year-old female who has had symptoms of TN for more than twenty years before undergoing gamma-knife SRS in 2017 with a dose of 90 Gray (Gy). Post SRS had good pain control for the next five years until in 2022 when she had increasing intensity of the pain no longer tolerable by medications. She was then treated in our institution using a linac-based SRS for a dose of 70 Gy. Post-second SRS, she reported no recurrence of severe pain. Twelve month follow-up noted no recurrence of severe pain with good quality of life and the only complication is unilateral left facial numbness. Repeat radiation with stereotactic radiosurgery with different techniques is feasible in refractory case of trigeminal neuralgia.