Repeat gamma knife radiosurgery for recurrent trigeminal neuralgia: a systematic review and meta-analysis

INTRODUCTION: Trigeminal neuralgia is a disorder of the trigeminal nerve that results in intense episodic pain. Medical management is commonly used as the first therapeutic intervention; however, some patients become resistant to it, requiring further interventions. Stereotactic radiosurgery with the Gamma Knife (GK) is safe and effective in multiple retrospective series. However, in some cases, repeat radiosurgery may be needed, aiming to improve the patient's pain in the long term. METHODS: We performed a systematic review and meta-analysis following the PRISMA guidelines. We included papers in English that reported patients with trigeminal neuralgia who didn't have their pain solved with standalone medications or a single dose of GK, needing repeat GK. All statistical analyses were conducted using R. RESULTS: = 55.6-91.8%, p < 0.0001), indicating inter-study variability. CONCLUSION: Repeat GKRS is a safe and effective option for TN patients experiencing persistent or recurrent pain after initial radiosurgery. Despite inter-study variability, outcomes support its use for long-term pain control. Further prospective studies are needed to optimize patient selection and treatment parameters.