Linear Accelerator Radiosurgery Using 90 Gray for Essential Trigeminal Neuralgia: Results and Dose Volume Histogram Analysis

Abstract

Dedicated linear accelerator-based stereotactic radiosurgery that uses a 5-mm collimator to deliver 90 Gy to the nerve root entry zone is a safe and effective method for the treatment of essential trigeminal neuralgia. Care should be taken to limit brainstem volume included in the 50% isodose line in the treatment plan to avoid facial numbness.

Dedicated Linear Accelerator Radiosurgery for Trigeminal Neuralgia: A Single-Center Experience in 179 Patients With Varied Dose Prescriptions and Treatment Plans

“…The correlation between the dose delivered to the brainstem and the incidence of trigeminal nerve dysfunction has been previously suggested (11,16,21,24,31,32). This association is grounds for an argument for a more anterior target, located away from the brainstem.…”

“…At other centers, significant pain relief at follow-up ranges from 70% to 95% (9,17,(20)(21)(22)(23)(24). We reported our initial series on 60 TN patients treated with a dedicated D-LINAC in 2003 (12,16) and other centers have now demonstrated equally positive results (25)(26)(27)(28).…”

“…The dedicated linear accelerator used in all patients was a Novalis D-LINAC, dedicated to radiosurgery, which provides mechanical dose delivery to the isocenter with a precision to 0.4 mm. The technique and application of this device have been previously described (15,16).…”

The Efficacy and Safety of Microvascular Decompression for Hemifacial Spasm in Elderly Patients

“…Radiosurgery has the advantages of short procedure duration and the need for only local anesthesia. However, it is associated with inferior long-term outcomes and a higher incidence of recurrence than MVD 10) . In the relevant literature, the efficacy of MVD is consistently superior to other surgical modalities.…”

Historical Development of Stereotactic Ablative Radiotherapy

“…The development of dynamic arc delivery, in which the leaves move during rotational delivery to continuously shape to the beams-eye-view projection of the target, further improved conformality and reduced average treatment times to approximately 15 min . Circular collimators mounted beneath the MLC enabled the Novalis to become the first linac system used routinely in the treatment of trigeminal neuralgia (Solberg et al 1998;Goss et al 2003;Smith et al 2003). In 2000, BrainLAB provided an IMRT solution for the Novalis, with inverse planning based on the dynamically penalized maximum likelihood (DPL) algorithm described by Llacer (1997).…”