Stereotactic Radiosurgery for Tumor-Related Trigeminal Neuralgia

Stereotactic radiosurgery (SRS) is a non-invasive technique that delivers highly focused radiation to a defined target. In the case of tumor-related trigeminal neuralgia, SRS may be used to:

• Control or reduce the size of the tumor causing nerve compression
• Provide pain relief by reducing tumor mass effect or direct nerve targeting

• Tumors in close proximity to the trigeminal nerve root entry zone
• Patients who are not candidates for surgery (due to age, comorbidities, or tumor location)
• Tumors with slow growth (e.g., meningiomas, schwannomas)
• Persistent pain despite prior tumor surgery

• Radiation leads to tumor growth arrest or shrinkage over time
• Reduces mechanical compression or inflammatory changes near the trigeminal nerve
• In some cases, the nerve itself can be targeted (similar to classical TN radiosurgery)

• Gamma Knife: most widely used for cranial SRS
• CyberKnife
• LINAC-based systems

• High-resolution MRI and CT are fused to define:
  1. Tumor margins
  2. Proximity to trigeminal nerve
• Single-session treatment with precise dosimetry
• Dose depends on tumor type, size, and nerve tolerance

• Tumor control: High for benign tumors (>90% at 5 years)
• Pain relief:
  1. May be delayed (weeks to months)
  2. Variable depending on tumor type and duration of symptoms
  3. Better outcomes when pain is paroxysmal rather than constant

• Trigeminal sensory loss (hypoesthesia, paresthesias)
• Rare: radiation necrosis, especially with large tumors
• Facial numbness may correlate with pain relief but can be bothersome
• Adjacent cranial nerve dysfunction (e.g., CN VI, VII, VIII) if radiation fields are not tightly confined

• MRI at 6 months, then annually to assess tumor control
• Neurological exams to monitor sensory changes or recurrence of pain

SRS is a valuable tool in the management of tumor-related trigeminal neuralgia, particularly in non-surgical candidates or as adjuvant therapy. While pain relief is less predictable than in classical TN radiosurgery, tumor control and reduced nerve compression can significantly improve symptoms.

Stereotactic Radiosurgery for Tumor-Related Trigeminal Neuralgia Systematic reviews and meta-analysis