Face the Pain: Radiobiological and Clinical Considerations of Re-radiosurgery to the Trigeminal Nerve Following Irradiation of an Abutting Petroclival Meningioma.

Trigeminal neuralgia is a common symptom of benign tumors compressing the trigeminal nerve, leading to debilitating pain and a devastating impact on quality of life. Stereotactic radiosurgery is a validated option for intracranial meningiomas with excellent tumor control rates that correlate with symptomatic improvement. Select cases with refractory or recurrent trigeminal neuralgia can benefit from a second treatment targeting the trigeminal nerve. We present a case of refractory trigeminal neuralgia secondary to compression of a previously irradiated petroclival meningioma successfully treated with a second radiosurgery course targeting cranial nerve V (CN V). Multidisciplinary considerations, patient-centered factors, radiobiological considerations, and technical challenges faced in the intracranial reirradiation setting when cumulative dose constraints are previously met or exceeded are discussed.