Radiosurgery for trigeminal neuralgia: the state of art.

The trigeminal neuralgia (TN) is a chronic, episodic, and disabling facial pain syndrome. It is a relatively rare disorder. Despite this, because of the intensity of the pain, TN may have a dramatic impact for many patients. Fortunately, most of the patients may obtain a good pain relief simply by taking drugs. Historically, the surgical approaches represent a true treatment paradigm for all the drug-resistant TN. In this context, radiosurgery (RS) is a relatively new treatment modality. The effectiveness and safety of radiosurgery are today widely accepted and the technique can be proposed to many patients which suffer from a drug-resistant TN. This is true especially when the patients are less than ideal candidates for an open surgery, or for elderly ones, when a clear neuro-vascular conflict is not evident. The present review provides a concise analysis of the actual indications for radiosurgery, as well as the most acknowledged prognostic factors. The pathogenesis of TN and the rationale for the RS efficacy are also investigated and described. Some technical aspects including the target selection and the prescription doses, which have widely changed in time, are depicted. In conclusion, the present review supports the idea that TN is a complex disease and radiosurgery represents an effective and relatively new treatment modality, which enriches the treatment armamentarium for these unfortunate patients. To optimize the RS results, a correct patient selection has to be performed.