Radiofrequency ablation and gamma knife radiosurgery for older patients with painful traumatic trigeminal neuropathy: a clinical outcomes study

Objective: Painful traumatic trigeminal neuropathy (PTTN) is a rare but debilitating disorder with limited effective treatment options, particularly in older patients. Pharmacologic therapies often yield suboptimal pain control, necessitating interventional approaches. This study evaluated the clinical outcomes of radiofrequency ablation (RFA) and gamma knife radiosurgery (GKS) in older patients with medically refractory PTTN.Methods: We retrospectively reviewed six patients treated between March 2018 and December 2024. The mean age was 64 years (range, 30–84), and five patients were female. Etiologies included facial trauma (n=3) and dental procedures (n=3). All patients had persistent pain (visual analog scale [VAS] ≥7) despite pharmacologic therapy and nerve block interventions. Two patients underwent RFA targeting the trigeminal ganglion, and four underwent GKS directed at the cisternal segment of the trigeminal nerve (mean maximum dose, 84.5 Gy). Pain outcomes were assessed using VAS scores.Results: All patients reported pain reduction following intervention. In the RFA group, VAS scores improved from 8 to 4 in one patient and from 10 to 4 in another, though one experienced symptom recurrence every 3 months despite repeated procedures. In the GKS group, VAS scores improved from 8 to 6, 7 to 4, 8 to 3, and 7 to 2. No major treatment-related complications were observed.Conclusion: Both RFA and GKS provide moderate pain relief in older patients with refractory PTTN. RFA offers rapid but sometimes short-lived benefit, whereas GKS achieves more sustained partial improvement. Individualized treatment strategies may optimize outcomes, and larger, long-term studies are needed to establish standardized protocols.