Gamma Knife Radiosurgery as a Surgical Alternative in Tolosa–Hunt Syndrome: A Comprehensive Literature Review

Abstract

Tolosa–Hunt Syndrome (THS) is a rare idiopathic granulomatous inflammatory disorder involving the cavernous sinus, superior orbital fissure, or orbital apex, and is clinically characterized by painful ophthalmoplegia. Corticosteroids remain the first-line therapy due to their rapid anti-inflammatory effects and significant symptom relief. However, long-term use is often limited by recurrence, steroid resistance, and adverse systemic or psychiatric effects. This literature review aims to evaluate the role of Gamma Knife radiosurgery (GKR) as an alternative or adjunctive treatment in patients with refractory or steroid-intolerant THS. A comprehensive search of recent literature was conducted, focusing on case reports and small case series discussing radiosurgical management of THS. The findings suggest that GKR offers a targeted, minimally invasive approach that delivers precise radiation to affected areas while minimizing exposure to surrounding neural structures. Clinical outcomes from the reviewed studies demonstrate effective pain relief, improvement of cranial nerve function, and sustained symptom control with relatively low complication rates. Although there is a theoretical risk of delayed radiation-induced effects, no significant radiological or clinical complications were reported during the available follow-up periods. GKR appears to be a promising therapeutic option in selected patients, particularly those with recurrent or steroid-resistant disease. Further prospective studies are required to establish standardized protocols and confirm long-term safety and efficacy of this treatment modality.