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Case description:

A case of a 37-year-old female patient suffering from refractory bilateral trigeminal neuralgia is presented, she underwent various interventions such as acupuncture, block therapies and even microvascular decompression without effective pain relief.

Clinical findings:

Paresthesias and shooting-like twinges of pain intensity 10/10 in bilateral maxillary and mandibular branches of the trigeminal nerve, with nasal and intraoral triggers that made eating impossible, becoming increasingly severe since refractoriness to microvascular decompression and carbamazepine, triggering the twinges even during sleep, generating somnolence, depressive mood and social isolation.

Treatment and results:

The patient was evaluated by an interdisciplinary neuro-oncology team, where, in accordance with the analysis of the brain magnetic resonance imaging and the patient's history, it was indicated to perform Cyberknife® radiosurgery in mono-fraction on the left trigeminal and subsequently treat the contralateral trigeminal. When treated with Cyberknife® radiosurgery, the patient reported absolute improvement in her pain for 2 years. 

Clinical relevance:

Radiosurgery by CyberKnife is not yet the first line of management in trigeminal neuralgia, however, it should be considered since several studies have managed to demonstrate an increase in the quality of life of patients and pain relief in refractory or severe cases. of said pathology.

Alma Luz Luna, Universidad de Sucre


Jaime Andrés González, Universidad de Sucre, Facultad Ciencias de la Salud, Grupo de Ciencias Médicas y Farmacéuticas. Sincelejo, Colombia, Clínica Santa María, Sincelejo, Colombia.


Linda Lucía Guardo, Universidad de Sucre


Nerlis Paola Pajaro Castro, Universidad de Sucre, Facultad Ciencias de la Salud, Grupo de Ciencias Médicas y Farmacéuticas


Luna, A. L., González, J. A., Guardo, L. L., & Pajaro Castro, N. P. (2023). CyberKnife Radiosurgery for refractory bilateral trigeminal neuralgia. Case report. Colombia Medica, 53(4), e5005283. (Original work published December 30, 2022)

Merskey H, Bogduk N. Classification of chronic pain. Descriptors of chronic pain syndromes and definitions of pain terms. 2.a ed. Seattle: IASP Press; 1994.

Alcántara MA, Sánchez CCI. Actualización en el manejo de la neuralgia del trigémino. Semer Med Fam. 2016; 42(4): 244-53. PMid:26643391

Li Y, Yang L, Ni J, Dou Z. Microvascular decompression and radiofrequency for the treatment of trigeminal neuralgia: a meta-analysis. J Pain Res. 2019; 12: 1937-45. PMid:31303785 PMCid:PMC6605044

Sanchez SL, Párraga RG. Descompresión microvascular para el tratamiento de la neuralgia del trigémino. Gac Med Bol. 2020;43(1): 67-73.

Green TH, Girgis F. Trigeminal neuralgia: medical management and surgical options. J Pain Palliat Care Pharmacother. 2019; 33(1-2): 32-3. PMid:31369323

Tian C, Wang X, Wu S, Liu Y, Luo R. Letter: pain outcomes following microvascular decompression for drug-resistant trigeminal neuralgia: a systematic review and meta-analysis. Neurosurgery. 2020;86(3): E353-4. PMid:31748783

Campero A, Ajler P, Campero Aa. Descompresión microvascular en neuralgia del trigémino: Reporte de 36 casos y revisión de la literatura. Surg Neurol Int. 2014;5(12):441. PMid:25379343 PMCid:PMC4220413

Liao J-J, Cheng W-C, Chang C-N, Yang J-T, Wei K-C, Hsu Y-H, et al. Reoperation for recurrent trigeminal neuralgia after microvascular decompression. Surg Neurol. 1997;47(6):562-8. DOI: 10.1016/S0090-3019(96)00250-9 PMid:9167781

Mora DI, Martínez SJE, Fernández HLS, Rosa GA, Jiménez PRE, Hidalgo CT. Análisis de decisión: coste-efectividad en el tratamiento quirúrgico de la neuralgia del trigémino. Rev la Soc Española Dolor. 2013;20(4):161-9.

Chumpitaz CV, Sayán SC, Ruíz RE, Franco QC, Eche HJ, Caldas CV, et al. Actualización de criterios diagnósticos y tratamiento de la neuralgia del trigémino. Odontol Sanmarquina. 2014; 16(1):44.

Tavakol S, Jackanich A, Strickland BA, Marietta M, Ravina K, Yu C, et al. Effectiveness of gamma knife radiosurgery in the treatment of refractory trigeminal neuralgia: a case series. Oper Neurosurg. 2020;18(6):571-6. PMid:31620790

Romanelli P, Conti A, Redaelli I, Martinotti AS, Bergantin A, Bianchi LC, et al. Cyberknife Radiosurgery for Trigeminal Neuralgia. Cureus. 2019;11(10): e6014.

Berti A, Ibars G, Wu X, Sabo A, Granville M, Suarez G, et al. Evaluation of CyberKnife radiosurgery for recurrent trigeminal neuralgia. Cureus. 2018;10(5): e2598. DOI: 10.7759/cureus.2598

Lakshman V, Aal M, Karumanchi P, Jaleel A, Iyer A. Trigeminal neuralgia secondary to vertebrobasilar dolichoectasia treated with cyberknife stereotactic radiosurgery. Asian J Neurosurg. 2019;14(3):978. DOI: 10.4103/ajns.ajns_53_18

PMid:31497145 PMCid:PMC6703046

Calcerrada N, Sabés R. Efectividad, seguridad y estimación de costes del sistema de radiocirugía Cyberknife. 1st ed. Madrid: Agencia Laín Entralgo; 2005.

Ho CC, Khan SA, Whealy MA. Neuralgia trigeminal. UpToDate; 2020. Disponibel en:

Fleetwood IG, Innes AM, Hansen SR, Steinberg GK. Familial trigeminal neuralgia. J Neurosurg. 2001;95(3):513-7. PMid:11565877

International Headache Society. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders 3rd edition. Cephalalgia. 2018; 38(1):1-211.

Serrano RAA, Martínez MJdeJ, Revuelta GR, Gómez AJL, Martínez AJJ, Ponce GJA, et al. Radiocirugía estereotáctica con acelerador lineal para el tratamiento de la neuralgia trigeminal. Experiencia de nueve años en una sola institución. Rev Neurol. 2014;59(06):249. PMid:25190337

Chaves JPG, de Oliveira TVHF, Francisco AN, Trintinalha MdeO, Carvalho NVP. Trigeminal neuralgia recurrence: a comparison of microvascular decompression and percutaneous balloon compression: a five years follow-up study. Arq Neuropsiquiatr. 2021;79(1):51-5. PMid:33656112


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Received 2022-05-25
Accepted 2023-02-23
Published 2023-06-08