Radiosurgical Management of Trigeminal Neuralgia

Trigeminal neuralgia (TN) is a disabling pain syndrome that afflicts one or more branches of the trigeminal nerve. When medical management fails, several surgical therapies exist, with varying rates of success. Stereotactic radiosurgery (SRS) has gained traction as a primary form of treatment for medically refractory TN, especially in patients with advanced age and medical comorbidities or those in whom invasive procedures may be contraindicated. As our understanding of radiobiology has increased, a wealth of literature has accumulated regarding the indications, treatment planning, and delivery of radiosurgery for TN. Although no universal consensus exists to date, we review in this chapter generally agreed upon practice principles, complication profiles, and toxicity mitigation strategies. We also briefly discuss the use of SRS in special instances of TN, such as in the treatment of TN secondary to multiple sclerosis (MS), compressive mass lesions, and recurrent TN.