ZAP-X: A Novel Radiosurgical Device for the Treatment of Trigeminal Neuralgia

Romanelli, Pantaleo; Chuang, Cynthia; Meola, Antonio; Bodduluri, R. M. C.; Adler, John R.

doi:10.7759/cureus.8324

Cited by 5 publications

(5 citation statements)

References 10 publications

(26 reference statements)

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“…conducted a preliminary dosimetric comparison of trigeminal neuralgia plans between ZAP-X and CyberKnife. They found that the two modalities yielded comparable plans for such functional treatment, and also highlighted the potential clinical value of ZAP-X in low dose region ( 31 ). Several studies have investigated the dosimetric characteristic of CyberKnife compared with other techniques, such as Gamma Knife and volumetric modulated arc therapy (VMAT) ( 32 – 35 ).…”

Section: Introductionmentioning

confidence: 90%

Comparative analysis of plan quality and delivery efficiency: ZAP-X vs. CyberKnife for brain metastases treatment

Niu,

Rashid,

Lee

et al. 2024

Front. Oncol.

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Purpose/ObjectivesZAP-X, a novel and dedicated radiosurgery (SRS) system, has recently emerged, while CyberKnife has solidified its position as a versatile solution for SRS and stereotactic body radiation therapy over the past two decades. This study aims to compare the dosimetric performance and delivery efficiency of ZAP-X and CyberKnife in treating brain metastases of varying target sizes, employing circular collimation.Methods and materialsTwenty-three patients, encompassing a total of 47 brain metastases, were included in the creation of comparative plans of ZAP-X and CyberKnife for analysis. The comparative plans were generated to achieve identical prescription doses for the targets, while adhering to the same dose constraints for organs at risk (OAR). The prescription isodose percentage was optimized within the range of 97–100% for each plan to ensure effective target-volume coverage. To assess plan quality, indices such as conformity, homogeneity, and gradient (CI, HI, and GI) were computed, along with the reporting of total brain volumes receiving 12Gy and 10Gy. Estimated treatment time and monitor units (MUs) were compared between the two modalities in evaluating delivery efficiency.ResultsOverall, CyberKnife achieved better CI and HI, while ZAP-X exhibited better GI and a smaller irradiated volume for the normal brain. The superiority of CyberKnife’s plan conformity was more pronounced for target size less than 1 cc and greater than 10 cc. Conversely, the advantage of ZAP-X’s plan dose gradient was more notable for target sizes under 10 cc. The homogeneity of ZAP-X plans, employing multiple isocenters, displayed a strong correlation with the target’s shape and the planner’s experience in placing isocenters. Generally, the estimated treatment time was similar between the two modalities, and the delivery efficiency was significantly impacted by the chosen collimation sizes for both modalities.ConclusionThis study demonstrates that, within the range of target sizes within the patient cohort, plans generated by ZAP-X and CyberKnife exhibit comparable plan quality and delivery efficiency. At present, with the current platform of the two modalities, CyberKnife outperforms ZAP-X in terms of conformity and homogeneity, while ZAP-X tends to produce plans with a more rapid dose falloff.

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Section: Introductionmentioning

confidence: 90%

Comparative analysis of plan quality and delivery efficiency: ZAP-X vs. CyberKnife for brain metastases treatment

Niu,

Rashid,

Lee

et al. 2024

Front. Oncol.

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“…Stereotactic radiosurgery combined with pharmacological treatment is currently one of the most acceptable alternatives for the treatment of TN [8], however, this treatment is one of the most demanding radiosurgery procedures because it requires precise dose delivery [9]. Regarding the mechanism of pain relief, is thought to be focal axonal degeneration of the trigeminal nerve, affecting more pain fibers proportionally than sensory fibers.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Short-Term Response in Refractory Trigeminal Neuralgia Treated With CyberKnife

Pérez Fernández,

Aquino,

Niño De Guzmán

et al. 2023

Cureus

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Stereotactic radiosurgery combined with pharmacological treatment is currently one of the most acceptable alternatives for the treatment of trigeminal neuralgia (TN). Our primary endpoint was to report the shortterm response (one month) outcomes of 10 patients with refractory TN after CyberKnife ® (CK) radiosurgery; secondary endpoints were to assess early side effects and complications. MethodsTen female patients with TN refractory to pharmacological and/or non-pharmacological treatment received a single dose of 90 Gy with CyberKnife ® radiosurgery. Clinical and demographic characteristics were obtained from medical records. The visual analog scale (VAS) was used to assess facial pain before as well as seven, 15, and 30 days after treatment. Friedman test was performed to evaluate pain relief in treated patients. ResultsAll patients responded well to the CK and experienced initial adequate pain relief during the first 30 days (p<0.001). No significant differences (p=0.661) were found between six patients who received CK radiosurgery as the first treatment option and those who underwent other non-pharmacological treatments. One patient was re-irradiated with 75 Gy. Transient facial paresthesia was observed in 3/10 patients without any other complications. ConclusionHigh-tech CK treatment is safe, non-invasive, fast, with minimal side effects, and effective in achieving short-term pain relief in patients with refractory TN, even in those with multiple previous interventions. Given these results, we recommend evaluating CK radiosurgery as the first-line treatment of choice for trigeminal neuralgia refractory to pharmacological treatment.

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“…Among all conditions treated with SRS, the technical demands of treating TN are especially exacting; a very high radiation dose (60-120 Gy) must be delivered to a very small target immediately adjacent to highly critical anatomy, i.e., the brainstem. Maximal targeting accuracy and sharp dose falloff are mandatory [ 5 ]. While frame-based targeting was once felt to be essential, Romanelli et al have demonstrated that the requisite precision can also be achieved with image-guided (non-frame-based) localization [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, some of its technical attributes also seem well-suited for treating TN. Of note, a short (45 mm) source to axis distance (SAD), solid angle coverage of 2π or greater, and small-aperture collimators (including both 4 mm and 5 mm diameters) collectively provide an especially steep dose gradient [ 5 , 6 ]. Moreover, the 1500 MU/min dose rate of the Zap-X LINAC enables relatively fast treatment.…”

Section: Introductionmentioning

confidence: 99%

Trigeminal Rhizotomy Using Gyroscopic Radiosurgery: A Case Report

Klassen¹,

Ivaturi²,

Hendricks³

2022

Cureus

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Characterized by intense, episodic lancinating pain within the distribution of the trigeminal nerve, trigeminal neuralgia (TN) is the most common craniofacial pain syndrome. Failure of medical management requires the consideration of interventional procedures. Stereotactic radiosurgery (SRS) is one of the more commonly used surgical options. Herein, we report the first published case of a patient with TN treated in the ZAP-X (San Carlos, CA: ZAP Surgical Systems, Inc.) gyroscopic radiosurgery system. This 59-year-old man with multiple sclerosis and recurrent intractable left idiopathic TN following previous SRS was retreated in the Zap-X system using 100 isocentric 5 mm beams to a dose of 7500 cGy. At a three-month follow-up, the patient reported a 45% decrease in his visual analogue scale (VAS) and a reduced need for medication. Albeit preliminary, this initial experience highlights the feasibility of a self-shielded, cobalt-free, device for radiosurgically treating TN.

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ZAP-X: A Novel Radiosurgical Device for the Treatment of Trigeminal Neuralgia

Abstract: Open Access Original Article

Cited by 5 publications

References 10 publications

Comparative analysis of plan quality and delivery efficiency: ZAP-X vs. CyberKnife for brain metastases treatment

Comparative analysis of plan quality and delivery efficiency: ZAP-X vs. CyberKnife for brain metastases treatment

Evaluation of the Short-Term Response in Refractory Trigeminal Neuralgia Treated With CyberKnife

Trigeminal Rhizotomy Using Gyroscopic Radiosurgery: A Case Report

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