Dosimetric analysis of trigeminal nerve, brain stem doses in CyberKnife radiosurgery of trigeminal neuralgia

Sudahar, H; Kurup, P G G; Murali, V; Velmurugan, J

doi:10.4103/0971-6203.99225

Cited by 7 publications

(6 citation statements)

References 24 publications

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“…[ 87 ] The cyber knife provides the high precision of dose with the sparing of healthy tissues. [ 109 110 111 ] Effectiveness and safety of frameless stereotactic radiosurgery (SRS) using cyber knife system are comparable to frame bases SRS. [ 112 ] X-knife radiosurgery also provides effective pain relief with a low complication rate.…”

Section: Gamma Knife Radiosurgerymentioning

confidence: 99%

Trigeminal neuralgia

Yadav

Pande

et al. 2017

Asian J Neurosurg

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Trigeminal neuralgia (TN) is a sudden, severe, brief, stabbing, and recurrent pain within one or more branches of the trigeminal nerve. Type 1 as intermittent and Type 2 as constant pain represent distinct clinical, pathological, and prognostic entities. Although multiple mechanism involving peripheral pathologies at root (compression or traction), and dysfunctions of brain stem, basal ganglion, and cortical pain modulatory mechanisms could have role, neurovascular conflict is the most accepted theory. Diagnosis is essentially clinically; magnetic resonance imaging is useful to rule out secondary causes, detect pathological changes in affected root and neurovascular compression (NVC). Carbamazepine is the drug of choice; oxcarbazepine, baclofen, lamotrigine, phenytoin, and topiramate are also useful. Multidrug regimens and multidisciplinary approaches are useful in selected patients. Microvascular decompression is surgical treatment of choice in TN resistant to medical management. Patients with significant medical comorbidities, without NVC and multiple sclerosis are generally recommended to undergo gamma knife radiosurgery, percutaneous balloon compression, glycerol rhizotomy, and radiofrequency thermocoagulation procedures. Partial sensory root sectioning is indicated in negative vessel explorations during surgery and large intraneural vein. Endoscopic technique can be used alone for vascular decompression or as an adjuvant to microscope. It allows better visualization of vascular conflict and entire root from pons to ganglion including ventral aspect. The effectiveness and completeness of decompression can be assessed and new vascular conflicts that may be missed by microscope can be identified. It requires less brain retraction.

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Section: Gamma Knife Radiosurgerymentioning

confidence: 99%

Trigeminal neuralgia

Yadav

Pande

et al. 2017

Asian J Neurosurg

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“…Brain stem is the critical OAR, which is in closer vicinity to the trigeminal nerve target. [14] Hence, brainstem is the OAR, which is prone to get very high dose when compared to all other OARs drawn for the CyberKnife treatment planning of TN. Keeping this in mind the brain stem dose and the dose to soft-tissue, which is surrounding the nerve target, were also analyzed in this study.…”

Section: Methodsmentioning

confidence: 99%

“…However, due to technical advancements in precise targeting, linear accelerator based radiosurgery, and robotic radiosurgery are employed to treat the Trigeminal nerve target as a noninvasive frameless procedure. [91011121314] CyberKnife (Accuray, Sunnyvale, USA) is a robotic radiosurgery unit which is used to treat both intracranial and extracranial lesions stereotactically.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparative analysis between 5 mm and 7.5 mm collimators in CyberKnife radiosurgery for trigeminal neuralgia

Sudahar¹,

Kurup²,

Murali³

et al. 2013

J Med Phys

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Trigeminal neuralgia (TN) is treated in CyberKnife (Accuray Inc, Sunnyvale, USA) with the 5 mm collimator whose dosimetric inaccuracy is higher than the other available collimators. The 7.5 mm collimator which is having less dosimetric uncertainty can be an alternative for 5 mm collimator provided the dose distribution with 7.5 mm collimator is acceptable. Aim of this study is to analyze the role of 7.5 mm collimator in CyberKnife treatment plans of TN. The treatment plans with 5 mm collimators were re-optimized with 7.5 mm collimator and a bi-collimator system (5 mm and 7.5 mm). The treatment plans were compared for target coverage, brainstem doses, and the dose to normal tissues. The target and brainstem doses were comparable. However, the conformity indices were 2.31 ± 0.52, 2.40 ± 0.87 and 2.82 ± 0.51 for 5 mm, bi-collimator (5mm and 7.5 mm), 7.5 mm collimator plans respectively. This shows the level of dose spillage in 7.5 mm collimator plans. The 6 Gy dose volumes in 7.5 mm plans were 1.53 and 1.34 times higher than the 5 mm plan and the bi-collimator plans respectively. The treatment time parameters were lesser for 7.5 mm collimators. Since, the normal tissue dose is pretty high in 7.5 mm collimator plans, the use of it in TN plans can be ruled out though the treatment time is lesser for these 7.5 mm collimator plans.

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“…However, brainstem dose parameters, such as the brainstem volume encompassed by the 50% isodose line (45 Gy), were found to be associated with sensory deficits such as facial numbness . As a result, the brainstem is still more often considered as an organ at risk than as a target for TN SRS . In addition to insufficient data, the lack of consensus regarding the clinical implications of TN and brainstem dosimetry also stem from the complexity of the dose and outcome data, as there are many other confounding factors at play requiring robust analyses on large patient groups to unravel.…”

Section: Introductionmentioning

confidence: 99%