Stereotactic radiosurgery using CT cisternography and non-isocentric planning for the treatment of trigeminal neuralgia

Computer Aided Surgery : Official Journal of the International Society for Computer Aided Surgery
Michael LimJohn R Adler

Abstract

Frame-based radiosurgical rhizotomy has been shown in clinical studies to be effective for managing trigeminal neuralgia (TN). To date, however, only a small pilot study has been published for the frameless, image-guided CyberKnife system. We present our preliminary experience with 29 trigeminal neuralgia patients treated with the frameless CyberKnife using X-ray image-guided targeting, a novel CT method for target definition, and non-isocentric planning. All 29 patients failed previous medical therapy and 14 had undergone prior surgical procedures. CT iohexal cisternography was used to identify the 6- to 8-mm segment of nerve to be lesioned. The marginal dose ranged from 60 to 70 Gy (median 66.4 Gy) as defined at an average 79th percentile. The corresponding Dmax varied from 71.4 to 86.4 Gy (median 77.91 Gy). After a median 10-month follow-up, 26 of 29 (90%) patients rated their pain control as excellent and 3 (10%) reported no improvement. Median time to improvement was 6 days. No or only minor progression in numbness was reported by 22 of 29 (76%) patients, 4 of 29 (14%) patients reported worsening, and 3 of 29 (10%) reported the onset of severe ipsilateral facial numbness. Two patients whose target volume inadvertently incl...Continue Reading

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Citations

Oct 3, 2008·Neuropsychiatric Disease and Treatment·Rosanna TarriconeAndrea Casasco
Aug 6, 2011·Current Problems in Surgery·Karthikeyan PonnusamyMyriam J Curet
Sep 2, 2008·Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology·Nieves Calcerrada Díaz-SantosElena Andradas Aragonés
Jan 1, 2010·Reports of Practical Oncology and Radiotherapy : Journal of Greatpoland Cancer Center in Poznań and Polish Society of Radiation Oncology·Bindhu JosephAruna Ramachandra
Jan 30, 2009·Neurosurgery·John R AdlerScott G Soltys
Apr 22, 2008·Neurosurgery·Alan T VillavicencioJeffrey J Thramann
Jan 3, 2018·Neurosurgery·Pantaleo RomanelliGiancarlo Beltramo
Apr 28, 2018·Journal of Neurosurgery·Constantin TuleascaMarc Levivier
Sep 9, 2011·The Cochrane Database of Systematic Reviews·Joanna M Zakrzewska, Harith Akram
Mar 23, 2021·Advances in Radiation Oncology·Austin J LivingstonDavid R Friedland

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