Radiosurgery is an effective treatment for refractory trigeminal neuralgia. The cisternal portion of the trigeminal nerve is the typical target for SRS, but some target the proximal root entry zone near the brainstem while others target the more distal retrogasserian portion. In this study, 86 patients received 85 Gy in 1 fraction using GammaKnife SRS. The proximal REZ was targeted in 63%, and the distal retrogasserian portion in 37%. Proximal targets resulted in higher rates of complete pain response (46% v 31%) and complete medication de-escalation (39% v 13%). However, distal targeting had higher overall pain response (90% v 74%) and partial medication de-escalation (75% v 33%). There was no difference in duration of response between the different approaches. | Hopkins, Adv Radiat Oncol 2026
