Necrosis and Neurotoxicity of the Brainstem Following Stereotactic Radiosurgery for Trigeminal Neuralgia: How Much is Too Much?

Trigeminal neuralgia (TN) is a neurologic syndrome that presents with spontaneous episodes of severe electric shock-like pain along the trigeminal nerve dermatomes. Primary treatment strategies include antiseizure medication, surgical intervention such as microvascular decompression, and stereotactic radiosurgery (SRS). Given its effectiveness and noninvasive nature, SRS is advantageous for patients with surgical comorbidities or advanced age. Additionally, radiosurgery is associated with lower rates of retreatment and is widely available, which has driven the clinical adoption of TN SRS.