# Longitudinal imaging correlates of stereotactic radiosurgery for refractory trigeminal neuralgia: A case report of rapid pain relief with 18-month follow-up

## TL;DR

This case report shows that stereotactic radiosurgery rapidly relieves trigeminal neuralgia pain, with MRI tracking treatment effects over 18 months.

## Contribution

The study provides rare longitudinal MRI data linking radiological changes to clinical outcomes in refractory trigeminal neuralgia treated with SRS.

## Key findings

- Complete pain relief was achieved within 3 days and sustained for 18 months.
- MRI showed dynamic inflammatory changes at the trigeminal nerve root entry zone over time.
- Longitudinal imaging can help understand treatment response and guide clinical decisions.

## Abstract

Stereotactic radiosurgery (SRS) is a well-established treatment for refractory trigeminal neuralgia (TGN), but longitudinal imaging data correlating radiological changes with clinical outcomes remain limited. We present a 79-year-old male with idiopathic TGN involving the right V2 trigeminal nerve distribution, refractory to pharmacotherapy and prior trigeminal ganglion balloon compression. Using an advanced plate-based SRS system, a precision dose of 90.0 Gy was delivered to the trigeminal nerve root entry zone (REZ). The patient reported complete pain relief within 3 days, sustained through 18-month follow-up, with mild sensory changes (paresthesia, numbness) considered an acceptable trade-off for pain freedom. Serial MRI follow-up at 4, 6, 12, and 18 months demonstrated dynamic post-SRS inflammatory changes at the REZ—initial enhancement peaking at 6–12 months followed by resolution at 18 months—providing rare radiological insights into treatment response. This case reinforces SRS as an effective option for refractory TGN, particularly in elderly patients, while highlighting the prognostic value of longitudinal imaging to bridge gaps in understanding post-procedural radiological evolution.