Frameless Image-Guided Radiosurgery for Initial Treatment of Typical Trigeminal Neuralgia

Chen, Joseph C.T.; Rahimian, J.; Rahimian, Rombod; Arellano, A.; Miller, Michael J.; Girvigian, M.R.

doi:10.1016/j.wneu.2010.07.001

Cited by 32 publications

(35 citation statements)

References 30 publications

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“…[18] Table 2 highlights myriad studies in the literature that utilized a linear accelerator SRS for the treatment of TN. Our study corresponds with previous studies in that the patients with TN failed to respond to previous medical therapy.…”

Section: Discussionmentioning

confidence: 99%

“…[8] In addition, the frameless system avoids patient discomfort associated with frame application and is able to treat extracranial lesions. [5] The frameless approach corrects for positioning errors automatically due to the imaging guidance during the procedure.…”

Section: Discussionmentioning

confidence: 99%

“…[5] The frameless approach corrects for positioning errors automatically due to the imaging guidance during the procedure. [8] The imaging, planning, and treatment components may be performed in different sessions. In this respect, frameless SRS is valuable in developing more complicated SRS planning over a several day period.…”

Section: Discussionmentioning

confidence: 99%

“…[8] Chen et al . performed a study of 44 patients who were treated with frameless IGRS over an 18-month period.…”

Section: Discussionmentioning

confidence: 99%

“…[29] However, radiosurgery has a lower likelihood of complete pain relief and a higher likelihood of pain recurrence compared with either microvascular decompression or percutaneous rhizotomy. [8] In 1951, Leksell reported the initial use of SRS for the treatment of TN. [19] Utilizing an orthovoltage X-ray machine and stereotactic localization, this method offered long-lasting pain relief without complications in two patients.…”

Section: Introductionmentioning

confidence: 99%

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Frameless image-guided radiosurgery for trigeminal neuralgia

et al. 2017

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Background:Frameless image-guided radiosurgery (IGRS) is a safe and effective noninvasive treatment for trigeminal neuralgia (TN). This study evaluates the use of frameless IGRS to treat patients with refractory TN.Methods:We reviewed the records of 20 patients diagnosed with TN who underwent frameless IGRS treatments between March 2012 and December 2013. Facial pain was graded using the Barrow Neurological Institute (BNI) scoring system. The initial setup uncertainty from simulation to treatment and the patient intrafraction uncertainty were measured. The median follow-up was 32 months.Results:All patients’ pain was BNI Grade IV or V before the frameless IGRS treatment. The mean intrafraction shift was 0.43 mm (0.28–0.76 mm), and the maximum intrafraction shift was 0.95 mm (0.53–1.99 mm). At last follow-up, 8 (40%) patients no longer required medications (BNI 1 or 2), 11 (55%) patients were pain free but required medication (BNI 3), and 1 (5%) patient had no pain relief (BNI 5). Patients who did not have prior surgery had a higher odds ratio for pain relief compared to patients who had prior surgery (14.9, P = 0.0408).Conclusions:Frameless IGRS provides comparable dosimetric and clinical outcomes to frame-based SRS in a noninvasive fashion for patients with medically refractory TN.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…[8] Chen et al . performed a study of 44 patients who were treated with frameless IGRS over an 18-month period.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Frameless image-guided radiosurgery for trigeminal neuralgia

et al. 2017

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Linac‐based stereotactic radiosurgery (SRS) in the treatment of refractory trigeminal neuralgia: Detailed description of SRS procedure and reported clinical outcomes

Pokhrel

Sood

McClinton

et al. 2017

J Applied Clin Med Phys

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Purpose/ObjectivesTo present our linac‐based SRS procedural technique for medically and/or surgically refractory trigeminal neuralgia (TN) treatment and simultaneously report our clinical outcomes.Materials and MethodsTwenty‐seven refractory TN patients who were treated with a single fraction of 80 Gy to TN. Treatment delivery was performed with a 4 mm cone size using 7‐arc arrangement with differential‐weighting for Novalis‐TX with six MV‐SRS (1000 MU/min) beam and minimized dose to the brainstem. Before each treatment, Winston–Lutz quality assurance (QA) with submillimeter accuracy was performed. Clinical treatment response was evaluated using Barrow Neurological Institute (BNI) pain intensity score, rated from I to V.ResultsOut of 27 patients, 22 (81%) and 5 (19%) suffered from typical and atypical TN, respectively, and had median follow‐up interval of 12.5 months (ranged: 1–53 months). For 80 Gy prescriptions, delivered total average MU was 19440 ± 611. Average beam‐on‐time was 19.4 ± 0.6 min. Maximum dose and dose to 0.5 cc of brainstem were 13.4 ± 2.1 Gy (ranged: 8.4–15.9 Gy) and 3.6 ± 0.4 Gy (ranged: 3.0–4.9 Gy), respectively. With a median follow‐up of 12.5 months (ranged: 1–45 months) in typical TN patients, the proportion of patients achieving overall pain relief was 82%, of which half achieved a complete pain relief with BNI score of I‐II and half demonstrated partial pain reduction with BNI score of IIIA‐IIIB. Four typical TN patients (18%) had no response to radiosurgery treatment. Of the patients who responded to treatment, actuarial pain recurrence free survival rates were approximately 100%, 75%, and 50% at 12 months, 15 months, and 24 months, respectively. Five atypical TN patients were included, who did not respond to treatment (BNI score: IV–V). However, no radiation‐induced cranial‐toxicity was observed in all patients treated.ConclusionLinac‐based SRS for medically and/or surgically refractory TN is a fast, effective, and safe treatment option for patients with typical TN who had excellent response rates. Patients, who achieve response to treatment, often have durable response rates with moderate actuarial pain recurrence free survival. Longer follow‐up interval is anticipated to confirm our clinical observations.

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