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CyberKnife radiosurgical rhizotomy for the treatment of atypical trigeminal nerve pain.
Neurosurg Focus. 2007; 23(6):E9.NF

Abstract

OBJECT

Patients with atypical trigeminal neuralgia (TN) have unilateral pain in the trigeminal distribution that is dull, aching, or burning in nature and is constant or nearly constant. Studies of most radiosurgical and surgical series have shown lower response rates in patients with atypical TN. This study represents the first report of the treatment of atypical TN with frameless CyberKnife stereotactic radiosurgery (SRS).

METHODS

Between 2002 and 2007, 7 patients that satisfied the criteria for atypical TN and underwent SRS were included in our study. A 6-8-mm segment of the trigeminal nerve was targeted, excluding the proximal 3 mm at the brainstem. All patients were treated in a single session with a median maximum dose of 78 Gy and a median marginal dose of 64 Gy.

RESULTS

Outcomes in 7 patients with a mean age of 61.6 years and a median follow-up of 20 months are reported. Following SRS, 4 patients had complete pain relief, 2 had minimal pain relief with some decrease in the intensity of their pain, and 1 patient experienced no pain relief. Pain relief was reported within 1 week of SRS in 4 patients and at 4 months in 2 patients. After a median follow-up of 28 months, pain did not recur in any of the 4 patients who had reported complete pain relief. Complications after SRS included bothersome numbness in 3 patients and significant dysesthesias in 1 patient.

CONCLUSIONS

The authors have previously reported a 90% rate of excellent pain relief in patients with classic TN treated with CyberKnife SRS. Compared with patients with classic TN, patients with atypical TN have a lower rate of pain relief. Nevertheless, the nearly 60% rate of success after SRS achieved in this study is still comparable to or better than results achieved with any other treatment modality for atypical TN.

Authors+Show Affiliations

Patil CG
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California 94305-5327, USA. chiragpatil@gmail.com
Veeravagu A
No affiliation info available
Bower RS
No affiliation info available
Li G
No affiliation info available
Chang SD
No affiliation info available
Lim M
No affiliation info available
Adler JR
No affiliation info available

MeSH

AdultAgedAged, 80 and overFemaleFollow-Up StudiesHumansMaleMiddle AgedRadiosurgeryRadiotherapy DosageRetrospective StudiesRhizotomyTreatment OutcomeTrigeminal Neuralgia

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18081486

Citation

Patil, Chirag G., et al. "CyberKnife Radiosurgical Rhizotomy for the Treatment of Atypical Trigeminal Nerve Pain." Neurosurgical Focus, vol. 23, no. 6, 2007, pp. E9.
Patil CG, Veeravagu A, Bower RS, et al. CyberKnife radiosurgical rhizotomy for the treatment of atypical trigeminal nerve pain. Neurosurg Focus. 2007;23(6):E9.
Patil, C. G., Veeravagu, A., Bower, R. S., Li, G., Chang, S. D., Lim, M., & Adler, J. R. (2007). CyberKnife radiosurgical rhizotomy for the treatment of atypical trigeminal nerve pain. Neurosurgical Focus, 23(6), E9.
Patil CG, et al. CyberKnife Radiosurgical Rhizotomy for the Treatment of Atypical Trigeminal Nerve Pain. Neurosurg Focus. 2007;23(6):E9. PubMed PMID: 18081486.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - CyberKnife radiosurgical rhizotomy for the treatment of atypical trigeminal nerve pain. AU - Patil,Chirag G, AU - Veeravagu,Anand, AU - Bower,Regina S, AU - Li,Gordon, AU - Chang,Steven D, AU - Lim,Michael, AU - Adler,John R,Jr PY - 2007/12/18/pubmed PY - 2008/2/6/medline PY - 2007/12/18/entrez SP - E9 EP - E9 JF - Neurosurgical focus JO - Neurosurg Focus VL - 23 IS - 6 N2 - OBJECT: Patients with atypical trigeminal neuralgia (TN) have unilateral pain in the trigeminal distribution that is dull, aching, or burning in nature and is constant or nearly constant. Studies of most radiosurgical and surgical series have shown lower response rates in patients with atypical TN. This study represents the first report of the treatment of atypical TN with frameless CyberKnife stereotactic radiosurgery (SRS). METHODS: Between 2002 and 2007, 7 patients that satisfied the criteria for atypical TN and underwent SRS were included in our study. A 6-8-mm segment of the trigeminal nerve was targeted, excluding the proximal 3 mm at the brainstem. All patients were treated in a single session with a median maximum dose of 78 Gy and a median marginal dose of 64 Gy. RESULTS: Outcomes in 7 patients with a mean age of 61.6 years and a median follow-up of 20 months are reported. Following SRS, 4 patients had complete pain relief, 2 had minimal pain relief with some decrease in the intensity of their pain, and 1 patient experienced no pain relief. Pain relief was reported within 1 week of SRS in 4 patients and at 4 months in 2 patients. After a median follow-up of 28 months, pain did not recur in any of the 4 patients who had reported complete pain relief. Complications after SRS included bothersome numbness in 3 patients and significant dysesthesias in 1 patient. CONCLUSIONS: The authors have previously reported a 90% rate of excellent pain relief in patients with classic TN treated with CyberKnife SRS. Compared with patients with classic TN, patients with atypical TN have a lower rate of pain relief. Nevertheless, the nearly 60% rate of success after SRS achieved in this study is still comparable to or better than results achieved with any other treatment modality for atypical TN. SN - 1092-0684 UR - https://www.unboundmedicine.com/medline/citation/18081486/CyberKnife_radiosurgical_rhizotomy_for_the_treatment_of_atypical_trigeminal_nerve_pain_ DB - PRIME DP - Unbound Medicine ER -