The effectiveness of Gamma Knife radiosurgery (GKRS) in treating trigeminal neuralgia (TN) has been demonstrated by a number of previous studies. However, there is a lack of research specifically documenting the initial and long-term outcomes of paroxysmal and persistent pain respectively following GKRS for TN with concomitant continuous pain (CCP). This study retrospectively analyzed pain outcomes and complications in 46 TN patients with CCP and 112 patients without CCP who underwent GKRS as initial surgical intervention at our institution from January 2019 to January 2024. Pain outcomes were classified as excellent (BNI I), good (BNI II–IIIa), and poor (BNI IIIb–V). Demographic and clinical data, pain outcomes, and complications were compared between patients with and without CCP. Subsequently, risk factors for poor outcomes after GKRS were evaluated using univariate and multivariate Cox regression analysis. The initial rate of poor outcomes in TN patients with CCP was similar to that of patients without CCP (15.8% vs 14.4%, P = .878). Following a minimum 6-month follow-up, the rate of poor pain outcomes increased to 37.0% in patients with CCP, compared to 38.4% in those without CCP (P = .968). Notably, the rate of long-term complete pain relief in patients without CCP was significantly higher than in those with CCP (35.7% vs 15.2%, P < .001). Poor response to medication (P < .001) was identified as an independent risk factors for poor outcomes after GKRS. While most TN patients with or without CCP can achieve favorable pain outcomes after GKRS, individuals with CCP were less likely to achieve complete pain relief compared to those without CCP.

Background: Hypertensive pontine hemorrhage (HPH) carries high mortality and disability, with no standardized treatment guidelines. This study compared treatment efficacy for severe HPH and identified prognostic factors to guide clinical decisions. Methods: We retrospectively analyzed consecutive severe HPH patients (GCS 4-7, hematoma volume ≥ 5 mL, isolated pontine hemorrhage) treated at our center (2020-2024), stratified into pharmacological therapy, stereotactic drainage, and craniotomy evacuation groups. To eliminate treatment choice confounding bias, we performed 1:1 Propensity score matching (PSM) to generate an unbiased 112-patient cohort (56 pharmacological, 56 surgical), with standardized mean difference < 0.10 defining excellent intergroup balance. All core analyses were performed exclusively on this PSM-matched unbiased cohort. Inverse probability of treatment weighting (IPW) was used only as a sensitivity analysis to validate primary finding robustness. We assessed 30/90-day mortality and unfavorable functional outcomes (modified Rankin Scale ≥ 4), and recorded perioperative complications, ICU and total hospital stay for all patients. Multivariate logistic regression identified independent prognostic factors. Results: Post-PSM, all baseline covariates were well-balanced, eliminating treatment choice confounding bias. In the matched cohort, the surgical group had significantly lower 30/90-day mortality and 90-day unfavorable functional outcomes versus the pharmacological group (all P < 0.05); the 30-day unfavorable functional outcome rate showed no significant difference between the two groups ( P = 0.087). These findings were fully validated by IPW sensitivity analysis. In surgical subgroup comparison, craniotomy achieved higher hematoma clearance but higher intracranial infection risk, while stereotactic drainage offered shorter ICU/hospital stays but higher rebleeding risk (all P < 0.05). Multivariate analysis identified older age, lower GCS score, larger hematoma volume, acute obstructive hydrocephalus, and massive hematoma morphology as independent adverse prognostic factors, with regular antihypertensive use as a protective factor. Conclusion: In this PSM-matched cohort, surgery correlated with significantly reduced 30/90-day mortality and 90-day unfavorable functional outcome risk, with stereotactic drainage and craniotomy showing divergent safety-efficacy profiles. Findings do not constitute formal treatment recommendations, but may inform individualized clinical decisions based on patient and hematoma characteristics. This retrospective single-center study cannot establish definitive causality; results should be interpreted cautiously, with large-scale multi-center prospective trials in unbiased populations needed to verify robustness.