Non-Cochrane · intervention · PM42065731
Repeat gamma knife radiosurgery for recurrent trigeminal neuralgia: a systematic review and meta-analysis.
Santana Maria Fernanda P, Palavani Lucca B, Ansari Yusuf-Zain, et al. · Acta neurochirurgica · 2026 · PubMed · doi:10.1007/s00701-026-06891-7
Findings
Population Patients with recurrent or refractory trigeminal neuralgia after prior Gamma Knife radiosurgery
21 findings
| Repeat Gamma Knife radiosurgery (GKRS) | No comparator (single-arm) | Pain recurrence after repeat GKRS Meta-regression moderator: Pain duration | Meta-regression coefficient -0.0004 GRADE not reported 8 studies |
| Repeat Gamma Knife radiosurgery (GKRS) | No comparator (single-arm) | Pain recurrence after repeat GKRS After repeat GKRS | Proportion (%) 29.07 [22.68, 35.46] GRADE not reported 14 studies · 1404 participants |
| Repeat Gamma Knife radiosurgery (GKRS) | No comparator (single-arm) | Masticatory deficit after repeat GKRS After repeat GKRS | Proportion (%) 2.93 [0.00, 9.04] GRADE not reported 2 studies · 67 participants |
| Repeat Gamma Knife radiosurgery (GKRS) | No comparator (single-arm) | Pain relief after repeat GKRS Meta-regression moderator: Age at first treatment | Meta-regression coefficient -0.0086 GRADE not reported 6 studies |
| Repeat Gamma Knife radiosurgery (GKRS) | No comparator (single-arm) | Pain recurrence after repeat GKRS Meta-regression moderator: Age at last treatment | Meta-regression coefficient -0.0057 GRADE not reported 7 studies |
| Repeat Gamma Knife radiosurgery (GKRS) | No comparator (single-arm) | Pain relief after repeat GKRS Meta-regression moderator: Age at last treatment | Meta-regression coefficient 0.0022 GRADE not reported 8 studies |
| Repeat Gamma Knife radiosurgery (GKRS) | No comparator (single-arm) | Facial hypoesthesia after repeat GKRS After repeat GKRS | Proportion (%) 39.04 [26.65, 51.42] GRADE not reported 12 studies · 564 participants |
| Repeat Gamma Knife radiosurgery (GKRS) | No comparator (single-arm) | BNI pain score I-III (favorable pain outcome) after latest treatment After latest (repeat) treatment | Proportion (%) 76.68 [69.70, 82.46] GRADE not reported 13 studies · 606 participants |
| Repeat Gamma Knife radiosurgery (GKRS) | No comparator (single-arm) | BNI pain score I-III (favorable pain outcome) at latest follow-up Latest available follow-up (median follow-up 14-74 months across studies) | Proportion (%) 61.94 [35.59, 82.74] GRADE not reported 8 studies · 350 participants |
| Repeat Gamma Knife radiosurgery (GKRS) | No comparator (single-arm) | Corneal dryness after repeat GKRS After repeat GKRS | Proportion (%) 10.99 [3.42, 21.54] GRADE not reported 3 studies · 199 participants |
| Repeat Gamma Knife radiosurgery (GKRS) | No comparator (single-arm) | Dysgeusia after repeat GKRS After repeat GKRS | Proportion (%) 11.31 [3.68, 21.74] GRADE not reported 2 studies · 53 participants |
| Repeat Gamma Knife radiosurgery (GKRS) | No comparator (single-arm) | Pain relief after repeat GKRS After repeat GKRS | Proportion (%) 68.44 [58.44, 78.44] GRADE not reported 12 studies · 1078 participants |
| Repeat Gamma Knife radiosurgery (GKRS) | No comparator (single-arm) | Dysesthesia after repeat GKRS After repeat GKRS | Proportion (%) 7.45 [2.59, 14.11] GRADE not reported 3 studies · 112 participants |
| Repeat Gamma Knife radiosurgery (GKRS) | No comparator (single-arm) | Pain recurrence after repeat GKRS Meta-regression moderator: Age at first treatment | Meta-regression coefficient -0.0109 GRADE not reported 9 studies |
| Repeat Gamma Knife radiosurgery (GKRS) | No comparator (single-arm) | BNI pain score I-III (favorable pain outcome) after prior treatment Before repeat GKRS (after prior treatment) | Proportion (%) 70.57 [25.81, 94.30] GRADE not reported 10 studies · 481 participants |
| Repeat Gamma Knife radiosurgery (GKRS) | No comparator (single-arm) | Pain relief after repeat GKRS Meta-regression moderator: Time since last GK | Meta-regression coefficient 0.0047 GRADE not reported 8 studies |
| Repeat Gamma Knife radiosurgery (GKRS) | No comparator (single-arm) | Pain recurrence after repeat GKRS Meta-regression moderator: Repeat GK dose | Meta-regression coefficient -0.0000 GRADE not reported 10 studies |
| Repeat Gamma Knife radiosurgery (GKRS) | No comparator (single-arm) | Pain recurrence after repeat GKRS Meta-regression moderator: Time since last GK | Meta-regression coefficient 0.0035 GRADE not reported 10 studies |
| Repeat Gamma Knife radiosurgery (GKRS) | No comparator (single-arm) | Paresthesia after repeat GKRS After repeat GKRS | Proportion (%) 11.81 [5.64, 19.57] GRADE not reported 3 studies · 92 participants |
| Repeat Gamma Knife radiosurgery (GKRS) | No comparator (single-arm) | Pain relief after repeat GKRS Meta-regression moderator: Pain duration | Meta-regression coefficient 0.0012 GRADE not reported 6 studies |
| Repeat Gamma Knife radiosurgery (GKRS) | No comparator (single-arm) | Pain relief after repeat GKRS Meta-regression moderator: Repeat GK dose | Meta-regression coefficient -0.0011 GRADE not reported 10 studies |
Included primary studies 25
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Brisman 2003 Repeat Gamma Knife Radiosurgery for Trigeminal Neuralgia DOI:10.1159/000075103 | 2003 | this review only | Pain relief after repeat GKRS; Dysesthesia after repeat GKRS | not extracted yet |
| Dhople 2007 Long Term Follow-up of Repeat Gamma Knife Stereotactic Radiosurgery for Refractory or Recurrent Trigeminal Neuralgia DOI:10.1016/j.ijrobp.2007.07.228 | 2007 | this review only | BNI pain score I-III (favorable pain outcome) after prior treatment; BNI pain score I-III (favorable pain outcome) after latest treatment; Facial hypoesthesia after repeat GKRS; Paresthesia after repeat GKRS | not extracted yet |
| Dvorak 2009 Retreatment of trigeminal neuralgia with Gamma Knife radiosurgery: is there an appropriate cumulative dose? DOI:10.3171/2008.11.jns08770 | 2009 | this review only | Dysgeusia after repeat GKRS; BNI pain score I-III (favorable pain outcome) after latest treatment; Pain relief after repeat GKRS; Pain recurrence after repeat GKRS; Facial hypoesthesia after repeat GKRS; Paresthesia after repeat GKRS; Dysesthesia after repeat GKRS; Masticatory deficit after repeat GKRS | not extracted yet |
| Franzini 2024 Repeat Gamma Knife radiosurgery for recurrent trigeminal neuralgia in patients with multiple sclerosis: a single-center retrospective study DOI:10.1007/s00701-024-05913-6 | 2024 | this review only | BNI pain score I-III (favorable pain outcome) at latest follow-up; Pain relief after repeat GKRS; Pain recurrence after repeat GKRS | not extracted yet |
| Franzini 2024 Repeat Gamma Knife radiosurgery for recurrent trigeminal neuralgia in patients with multiple sclerosis: a single-center retrospective study. PMID:38227059 | 2024 | this review only | not stated | not extracted yet |
| Gellner 2008 Recurrent trigeminal neuralgia: long term outcome of repeat gamma knife radiosurgery DOI:10.1136/jnnp.2007.142794 | 2008 | this review only | BNI pain score I-III (favorable pain outcome) at latest follow-up; Pain relief after repeat GKRS; Pain recurrence after repeat GKRS; Facial hypoesthesia after repeat GKRS | not extracted yet |
| Gupta 2021 Results of three or more Gamma Knife radiosurgery procedures for recurrent trigeminal neuralgia DOI:10.3171/2020.10.jns202323 | 2021 | this review only | BNI pain score I-III (favorable pain outcome) after prior treatment; BNI pain score I-III (favorable pain outcome) after latest treatment; BNI pain score I-III (favorable pain outcome) at latest follow-up; Pain relief after repeat GKRS; Pain recurrence after repeat GKRS; Facial hypoesthesia after repeat GKRS | not extracted yet |
| Hasegawa 2002 Repeat Radiosurgery for Refractory Trigeminal Neuralgia DOI:10.1097/00006123-200203000-00012 | 2002 | this review only | BNI pain score I-III (favorable pain outcome) after prior treatment; BNI pain score I-III (favorable pain outcome) after latest treatment; Pain relief after repeat GKRS; Pain recurrence after repeat GKRS | not extracted yet |
| Helis 2015 Repeat Radiosurgery for Trigeminal Neuralgia DOI:10.1227/neu.0000000000000915 | 2015 | this review only | BNI pain score I-III (favorable pain outcome) after prior treatment; Corneal dryness after repeat GKRS; BNI pain score I-III (favorable pain outcome) after latest treatment; Pain relief after repeat GKRS; Pain recurrence after repeat GKRS; Facial hypoesthesia after repeat GKRS | not extracted yet |
| Helis 2021 Results of a third Gamma Knife radiosurgery for trigeminal neuralgia DOI:10.3171/2020.2.jns192876 | 2021 | this review only | BNI pain score I-III (favorable pain outcome) after prior treatment; Corneal dryness after repeat GKRS; BNI pain score I-III (favorable pain outcome) after latest treatment; BNI pain score I-III (favorable pain outcome) at latest follow-up; Pain relief after repeat GKRS; Pain recurrence after repeat GKRS; Facial hypoesthesia after repeat GKRS | not extracted yet |
| Herman 2004 Importance of baseline mini-mental state examination as a prognostic factor for patients with low-grade glioma DOI:10.1016/j.ijrobp.2003.10.040 | 2004 | this review only | not stated | not extracted yet |
| Herman 2004 Repeat gamma knife radiosurgery for refractory or recurrent trigeminal neuralgia: treatment outcomes and quality-of-life assessment DOI:10.1016/j.ijrobp.2003.10.041 | 2004 | this review only | BNI pain score I-III (favorable pain outcome) after prior treatment; BNI pain score I-III (favorable pain outcome) after latest treatment; Facial hypoesthesia after repeat GKRS | not extracted yet |
| Huang 2010 Gamma Knife surgery for recurrent or residual trigeminal neuralgia after a failed initial procedure DOI:10.3171/2010.8.gks10915 | 2010 | this review only | BNI pain score I-III (favorable pain outcome) after latest treatment; Pain recurrence after repeat GKRS; Facial hypoesthesia after repeat GKRS | not extracted yet |
| Kano 2010 Outcome Predictors After Gamma Knife Radiosurgery for Recurrent Trigeminal Neuralgia DOI:10.1227/neu.0b013e3181fa098a | 2010 | this review only | BNI pain score I-III (favorable pain outcome) after latest treatment; BNI pain score I-III (favorable pain outcome) at latest follow-up; Pain recurrence after repeat GKRS | not extracted yet |
| Lee 2018 Early Stereotactic Radiosurgery for Medically Refractory Trigeminal Neuralgia DOI:10.1016/j.wneu.2018.01.088 | 2018 | this review only | BNI pain score I-III (favorable pain outcome) after prior treatment; Pain recurrence after repeat GKRS; Facial hypoesthesia after repeat GKRS | not extracted yet |
| Loving 2025 Outcomes and predictive factors after second stereotactic radiosurgery for refractory trigeminal neuralgia DOI:10.1016/j.ctro.2025.100969 | 2025 | this review only | BNI pain score I-III (favorable pain outcome) after prior treatment; Facial hypoesthesia after repeat GKRS; Paresthesia after repeat GKRS; Dysesthesia after repeat GKRS; Masticatory deficit after repeat GKRS | not extracted yet |
| Omar 2019 Repeat gamma knife stereotactic radiosurgery in the treatment of trigeminal neuralgia: A single-center experience and focused review of… DOI:10.1016/j.jocn.2019.08.061 | 2019 | this review only | Pain recurrence after repeat GKRS | not extracted yet |
| Omar 2019 Repeat gamma knife stereotactic radiosurgery in the treatment of trigeminal neuralgia: A single-center experience and focused review of… PMID:31447361 | 2019 | this review only | not stated | not extracted yet |
| Pollock 2002 Stereotactic radiosurgery for idiopathic trigeminal neuralgia DOI:10.3171/jns.2002.97.2.0347 | 2002 | this review only | BNI pain score I-III (favorable pain outcome) after latest treatment; Facial hypoesthesia after repeat GKRS | not extracted yet |
| Raval 2014 Salvage Gamma Knife Radiosurgery after failed management of bilateral trigeminal neuralgia. PMID:25525553 | 2014 | this review only | BNI pain score I-III (favorable pain outcome) at latest follow-up | not extracted yet |
| Seha 2025 Outcomes, Predictors of Retreatment, and Complications After Repeat Gamma Knife Radiosurgery for Trigeminal Neuralgia: A Single-Center… PMID:40772001 | 2025 | this review only | Dysgeusia after repeat GKRS; Corneal dryness after repeat GKRS; BNI pain score I-III (favorable pain outcome) after latest treatment; Pain relief after repeat GKRS; Facial hypoesthesia after repeat GKRS | not extracted yet |
| Tempel 2015 The results of a third Gamma Knife procedure for recurrent trigeminal neuralgia DOI:10.3171/2014.9.jns132779 | 2015 | this review only | BNI pain score I-III (favorable pain outcome) after prior treatment; BNI pain score I-III (favorable pain outcome) after latest treatment; BNI pain score I-III (favorable pain outcome) at latest follow-up; Pain relief after repeat GKRS; Pain recurrence after repeat GKRS | not extracted yet |
| Wang 2018 Gamma Knife Surgery for Recurrent Trigeminal Neuralgia in Cases with Previous Microvascular Decompression DOI:10.1016/j.wneu.2017.11.062 | 2018 | this review only | Pain relief after repeat GKRS; Pain recurrence after repeat GKRS | not extracted yet |
| Weller 2013 Single-Institution Retrospective Series of Gamma Knife Radiosurgery in the Treatment of Multiple Sclerosis-Related Trigeminal Neuralgia:… DOI:10.1159/000354815 | 2013 | this review only | BNI pain score I-III (favorable pain outcome) after prior treatment; BNI pain score I-III (favorable pain outcome) after latest treatment; BNI pain score I-III (favorable pain outcome) at latest follow-up; Pain relief after repeat GKRS; Pain recurrence after repeat GKRS | not extracted yet |
| Weller 2013 Single-institution retrospective series of gamma knife radiosurgery in the treatment of multiple sclerosis-related trigeminal neuralgia:… PMID:24217153 | 2014 | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients with trigeminal neuralgia not relieved by standalone medication or a single Gamma Knife dose | 2,486 patients initially treated; 2,020 undergoing repeat GKRS (n=21 studies); ~85% idiopathic TN |
| Intervention | Repeat Gamma Knife radiosurgery | Repeat GKRS, mainly trigeminal root entry zone, median marginal dose 70-80 Gy (n=21) |
| Comparison | Not specified | None (single-arm) |
| Outcomes | Pain relief (numeric rating scale, BNI score), pain recurrence, complications and adverse effects, repeat GK dose | BNI I-III after prior treatment (n=10), after latest treatment (n=13), at latest follow-up (n=8); pain relief (n=11); pain recurrence (n=13); facial hypoesthesia (n=12); paresthesia (n=3); dysesthesia (n=3); masticatory deficit (n=2); dysgeusia (n=2); corneal dryness (n=3) |
| Study designs | Studies reporting repeat Gamma Knife for trigeminal neuralgia; English only | 3 cohort and 18 retrospective studies |
| Timing | Minimum follow-up of 12 months | Median follow-up 14-74 months |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | No | Partial Yes | no |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | No | No | yes |
| 5Study selection in duplicate | No | No | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | NRSI: Yes · RCT: N/A | NRSI: Yes · RCT: N/A | yes |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | NRSI: Yes · RCT: N/A | RCT: N/A · NRSI: Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |