Ultra-Early Gamma Knife Surgery Shows Promise for Trigeminal Neuralgia Relief

A clinical trial at the University of Alberta Hospital is investigating whether immediate Gamma Knife stereotactic radiosurgery (GK-SRS) can provide more durable pain relief for trigeminal neuralgia (TN) than traditional treatment approaches. TN, often described as one of the most painful conditions known, causes excruciating facial pain triggered by everyday activities.

Understanding Trigeminal Neuralgia

Trigeminal neuralgia is a chronic pain condition affecting the trigeminal nerve, which carries sensation from the face to the brain. Even light touch can trigger intense, stabbing, or electric shock-like pain. Approximately 700 modern cases are diagnosed in Alberta each year. [1]

Current Treatments and Their Limitations

Initial treatment typically involves medications, often repurposed anti-seizure drugs. Although these can be effective, they frequently cause side effects such as blurry vision, imbalance, and allergies. Medications lose effectiveness in over half of patients. [1]

Gamma Knife Stereotactic Radiosurgery: A Non-Invasive Option

Gamma Knife surgery, a non-invasive form of radiation therapy, has traditionally been offered as a last resort when medications fail. It delivers a focused dose of radiation to the trigeminal nerve to reduce pain. However, research suggests that the effectiveness of Gamma Knife decreases the longer a patient waits for treatment. [1]

The University of Alberta Trial: A New Approach

The University of Alberta trial, led by Tejas Sankar, associate professor of surgery and neurosurgery research director, aims to determine if “ultra-early” Gamma Knife surgery – administered soon after diagnosis and before medications grow ineffective – can improve long-term outcomes. [1] The study is recruiting 80 patients from across the province. Participants will be randomly assigned to receive either immediate Gamma Knife surgery or continue with standard medical management. Those in the control group will have the option to receive Gamma Knife treatment later if their pain persists. [1]

Brain Changes and the Importance of Early Intervention

Research using functional MRI has shown that living with trigeminal neuralgia can cause lasting changes in brain structure and function. [1] The trial seeks to prevent these changes by intervening early in the disease process.

Study Details

The trial is a single-center, two-arm, randomized, controlled, parallel group design, pragmatic, noninferiority, phase II trial. [1] Participants will be treated within 2 years of being diagnosed with TN. [1] An intention-to-treat analysis will be conducted. [1] More information about the study (NCT06949436) is available on ClinicalTrials.gov.

Where to Find Treatment

The Scott and Brown Families Gamma Knife Centre at the University of Alberta Hospital is the only facility of its kind in the province offering this treatment. [4]