Stereotactic Radiosurgery for Trigeminal Neuralgia Utilizing the BrainLAB Novalis System

Zahra, H.; Teh, Bin S.; Paulino, Arnold C.; Yoshor, Daniel; Trask, Todd; Baskin, David S.; Butler, E. Brian

doi:10.1177/153303460900800602

Cited by 22 publications

(18 citation statements)

References 20 publications

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“…The Varian Truebeam (Varian, Palo Alto, CA) system is a LINAC-based platform that has been used for the treatment of TN [9-10]. Chen et al reported a 15-month follow-up of patients treated using a frameless LINAC system with patient outcomes similar to published data [9].…”

Section: Introductionmentioning

confidence: 94%

Truebeam Radiosurgery for the Treatment of Trigeminal Neuralgia: Preliminary Results at a Single Institution

Kerolus¹,

Sen²,

Mayekar³

et al. 2017

Cureus

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IntroductionRadiosurgery is now an established method of satisfactory pain control in patients with trigeminal neuralgia (TN). The Varian Truebeam STx (Varian Medical Systems, Palo Alto, CA) linear accelerator (LINAC) system is an arc-based, frameless stereotactic radiosurgery system used for the treatment of TN. To our knowledge, there has been only one published series of patient histories that documents the use of a frameless LINAC system for the treatment of TN. We describe the treatment parameters, patient outcomes, and complications associated with the treatment of TN.MethodsAll patients treated with the Truebeam system for TN between 2012 and 2015, with at least a six-month follow-up, were identified. A dose of 90 Gy was delivered to the isocenter using a 0.5 cm diameter cone. The cisternal segment of the trigeminal nerve was placed at the location of the LINAC isocenter using an ExacTrac™ (Brainlab, Munich, Germany) image guidance system. The radiosurgical dose, Barrow Neurologic Institute pain score (BNI PS), symptom recurrence, magnetic resonance imaging (MRI) radiographic changes, and other complications, including Barrow Neurologic Institute facial numbness score (BNI FN), were analyzed.ResultsA total of 18 patients—15 women and 3 men—with a mean age of 58 years (median: 59 years; range: 22-84 years) were treated at our institution. Fourteen patients (78%) had a BNI PS of IIIb or better, which was considered successful treatment. Twelve patients had excellent (BNI PS I) pain relief and two patients had good (BNI PS II-IIIB; recurrence after one year) pain relief. The pain of four patients recurred after a mean of 10 months.ConclusionTruebeam radiosurgery can provide effective and safe treatment for patients suffering from TN. The efficacy appears similar to other frame- and frameless-based systems

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Section: Introductionmentioning

confidence: 94%

Truebeam Radiosurgery for the Treatment of Trigeminal Neuralgia: Preliminary Results at a Single Institution

Kerolus¹,

Sen²,

Mayekar³

et al. 2017

Cureus

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“…The majority of LINAC SRS studies for TN have used a frame-based system with either a Novalis, Varian, or Primus device,[71213182426293035] whereas a few have reported the innovative frameless technique. [18] Table 2 highlights myriad studies in the literature that utilized a linear accelerator SRS for the treatment of TN.…”

Section: Discussionmentioning

confidence: 99%

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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“…Brainlab iPlan, although it is widely used for framed‐based SRS treatment planning, 15 , 16 , 17 does not provide a working solution for preplanning since CT image sets with the frame affixed to the patient are not available until the day of treatment. We developed an efficient, safe, and reliable preplanning procedure for frame‐based SRS within the framework of Brainlab iPlan system.…”

Section: Discussionmentioning

confidence: 99%

A preplanning method for stereotactic radiosurgery to improve treatment workflow

Ahn

Ozturk

Smith

et al. 2016

J Applied Clin Med Phys

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Frame‐based stereotactic radiosurgery (SRS) requires fixation of an invasive head ring to ensure accurate targeting. Minimizing waiting time with a fixed head ring is important for patient comfort and satisfaction. We report a practical preplanning solution for the Brainlab iPlan treatment planning system that reduces waiting time by expediting the planning process on treatment day. A water‐filled anthropomorphic head phantom was used to acquire a surrogate CT image set for preplanning and fused with patient's MRI, which was obtained before the day of treatment. Once an acceptable preplan was obtained, it was saved as a plan template and the phantom image set was removed from the Brainlab database to prevent any confusion and mix‐up of image sets. On the treatment day, the patient's CT and MRI were fused, and the customized beam settings of the preplan template were then applied and optimized. Up to 10‐fold of reduction in treatment plan time was demonstrated by bench testing with multiple planners and a variety of cases. Loading the plan template and fine‐tuning the preconfigured beam settings took only a small fraction of the preplan time to restore the conformity and dose falloff comparable to those of the preplan. For instance, preplan time was 2 hr for a two‐isocenter case, whereas, it took less than 20 min for a less experienced planner to plan it on the day of treatment using the preplan method. The SRS preplanning technique implemented in this study for the Brainlab iPlan treatment planning system offers an opportunity to explore possible beam configurations thoroughly, optimize planning parameters, resolve gantry angle clearance issues, and communicate and address challenges with physicians before the treatment day. Preplanning has been proven to improve plan quality and to improve efficiency in our clinic, especially for multiple‐isocenter and dosimetrically challenging cases.PACS number(s): 87.53.Ly, 87.55.D‐, 87.55.Gh, 87.55.tm

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Stereotactic Radiosurgery for Trigeminal Neuralgia Utilizing the BrainLAB Novalis System

Cited by 22 publications

References 20 publications

Truebeam Radiosurgery for the Treatment of Trigeminal Neuralgia: Preliminary Results at a Single Institution

Truebeam Radiosurgery for the Treatment of Trigeminal Neuralgia: Preliminary Results at a Single Institution

Frameless image-guided radiosurgery for trigeminal neuralgia

A preplanning method for stereotactic radiosurgery to improve treatment workflow

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