BACKGROUND AND OBJECTIVES: Trigeminal Neuralgia (TN) is a debilitating facial pain disorder, often necessitating surgical interventions when medication proves insufficient. Stereotactic Radiosurgery (SRS) is an established therapeutic option. Limited studies explored the feasibility of a third SRS procedure. Our study investigates the safety and efficacy of a third SRS procedure for recurrent TN. METHODS: We performed a retrospective analysis across multiple centers using databases collected prospectively. Pain status was evaluated utilizing the BNI Pain Intensity Scales. The Kaplan-Meier method was employed to estimate the time to recurrence, with group comparisons conducted using log-rank tests. Associations were explored using Chi-square and logistic regression models. RESULTS: Ten institutions contributed with a total of 35 patients. A third SRS revealed sustained effectiveness with a pain control rate of 82.7%. The median time to recurrence was 35.5 months. New sensory dysfunction following the third procedure occurred in 22% of patients who had preserved sensory function after the second procedure. When considering those who developed sensory dysfunction after the second procedure, 40% of the entire cohort was affected. There were no significant differences in pain recurrence intervals among the three procedures. A meta-analysis, combining data from previous studies, showed that 89.6% of patients achieved some degree of pain control after a third SRS, with 27.4% experiencing new sensory dysfunction and a median time to recurrence of 31.6 months. CONCLUSION: Our study, the largest on the topic, affirms the sustained effectiveness of a third SRS for TN, providing comparable pain relief to initial procedures. Notably, an extended pain-free interval after the third SRS session was observed. Facial sensory dysfunction emerged as the primary side effect. Larger studies are warranted to explore correlations with demographics and treatment parameters for a comprehensive understanding of repeat SRS in managing recurrent TN.

Department of Neurological Surgery Cleveland Clinic Cleveland OH USA

Department of Neurological Surgery IRCCS Humanitas Research Hospital IRCCS Rozzano Italy

Department of Neurological Surgery Koc University School of Medicine Istanbul Turkey

Department of Neurological Surgery Na Homolce Hospital Prague Czech Republic

Department of Neurological Surgery Neurological Institute Taipei Veteran General Hospital Taipei Taiwan

Department of Neurological Surgery NYU Langone Health New York NY USA

Department of Neurological Surgery PGIMER Chandigarh India

Department of Neurological Surgery Université de Sherbrooke Centre de Recherche du CHUS Sherbrooke QC Canada

Department of Neurological Surgery University of Manitoba Winnipeg MB Canada

Department of Neurological Surgery University of Miami Miami FL USA

Department of Neurological Surgery University of Virginia Health System Charlottesville VA USA

Vivian L Smith Department of Neurosurgery at McGovern Medical School Texas Institute for Restorative Neurotechnologies UTHealth Houston 6431 Fannin St Houston TX 77030 USA

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