a b s t r a c tRadiosurgery (RS) and hypofractionated stereotactic radiotherapy (HSRT) were performed in 23 and 22 patients respectively for the treatment of trigeminal neuralgia. RS and HSRT were performed with a dedicated linear accelerator (LINAC): an invasive frame (for RS) or a relocatable stereotactic frame fitted with a thermoplastic mask and bite blocks (HSRT) were used for positioning patients. The RS treatment delivered 40 Gy in a single fraction, or for HSRT, the equivalent radiobiological fractionated dose -a total of 72 Gy in six fractions. The target (the retrogasserian cisternal portion of the trigeminal nerve) was identified by fusion of CT scans with 1-mm-thick T2-weighted MRI, and the radiant dose was delivered by a 10-mm-diameter cylindrical collimator. The results were evaluated using the Barrow Neurological Institute pain scale during follow-up (mean 3.9 years). The 95% isodose was applied to the entire target volume. After RS (23 patients), Class 1 results were observed in 10 patients; Class II in nine, Class IIIa in two, Class IIIb in one, and Class V results in one patient. Facial numbness occurred in two (8.7%) patients, and the trigeminal neuralgia recurred in two patients (8.7%). Following HSRT (22 patients), Class I results were achieved in eight patients, Class II in eight, Class IIIa in four, and Class IIIb in two patients; recurrence occurred in six (27.5%), and there were no complications. Thus, both RS and HSRT provided effective and safe therapy for the treatment of trigeminal neuralgia. Patients who underwent RS experienced better pain relief and a lower recurrence rate, whereas those who underwent HRST had no side effects, and in particular, no facial numbness.

IntroductionTrigeminal neuralgia (TN) is a common cause of facial pain. Current supposed pathophysiology is that primary trigeminal neuralgia is caused by demyelination of trigeminal sensory fibers and that it often results from compression by an overlying artery or vein. Causes of symptomatic trigeminal neuralgia include multiple sclerosis and compressive space-occupying masses in the posterior fossa [1].Because of the lack of an unique therapeutic approach effective at the same way for all the patients affected from trigeminal neuralgia, many therapies are accomplishable, from pharmacological ones [2-4] to minor or major surgical procedures [5][6][7][8][9][10][11][12]; recently, radiosurgical therapies have an important role, too [13][14][15][16][17]. Pharmacological therapies should be the first therapeutic approach. In the study we report the surgical treatments which have been performed in a series of patients affected by TN.The aim of the presented study is to underline that TN not responsive to medical therapy should be approached with different surgical therapies according to neuralgia (interested division, gravity) and patient's characteristics (age and general conditions). We consider mandatory this analysis in order to achieve the best result performing in each patient the most appropriate therapeutic option. Materials and MethodsFour-hundred-thirty-seven patients affected from TN refractory to every previously performed medical therapy are presented; all the patients were affected from primary TN according to the criteria of the

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We report a case and discuss clinical features and radiological differential diagnosis of dorsal idiopathic extramedullary arachnoid cyst associated to a caudal syringomyelic cavitation. The aim of this article is to review the current literature on a rare topic as idiopathic intradural extramedullary arachnoid cyst with associated syringomyelia. We emphasize the fact that correct diagnosis and adequate treatment, which we believe is microsurgical fenestration of the cyst into the subarachnoid space, may lead to disappearance of syringomyelia and complete resolution of preoperative spinal cord compression symptoms.