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CyberKnife radiosurgery as a first treatment for idiopathic trigeminal neuralgia.
Neurosurgery. 2009 Feb; 64(2 Suppl):A96-101.N

Abstract

OBJECTIVE

To report the level of effectiveness and safety, in our experience, of CyberKnife (Accuray, Inc., Sunnyvale, CA) robotic radiosurgery as a first-line treatment against pharmacologically refractory trigeminal neuralgia.

METHODS

We treated 33 patients with the frameless CyberKnife system as a monotherapy. The retrogasserian portion of the trigeminal nerve (a length of 4 mm, 2-3 mm anterior to the root entry zone) was targeted. Doses of 55 to 75 Gy were prescribed to the 100% isodose line, according to a dose escalation protocol. The patients were evaluated for the level of pain control, time to pain relief, hypesthesia, and time to pain recurrence.

RESULTS

The median age was 74 years. All but 2 patients (94%) achieved a successful treatment outcome. The follow-up period was 9 to 37 months (mean, 23 months). The Barrow Neurological Institute Pain Intensity Scale (BPS) score before radiosurgery was III in 2 patients (6%), IV in 8 patients (24%), and V in 23 patients (70%). The time to pain relief was 1 to 180 days (median, 30 days). No facial numbness was observed. Only 1 patient developed a transitory dysesthesia of the tongue. After treatment, the BPS score was I, II, or III in 31 patients (97%). Pain recurred in 33% (11 patients) at a mean of 9 months (range, 1-43 months). Three patients with recurrences had low pain control by medication (BPS score, IV), and 1 patient (BPS score, V) needed a radiofrequency lesioning (BPS score, I at 12 months).

CONCLUSION

CyberKnife radiosurgery for trigeminal neuralgia allows pain relief at safe doses and is suggested for pharmacologically refractory trigeminal neuralgia. Higher prescribed doses were not associated with improvement in pain relief or recurrence rate.

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Authors+Show Affiliations

Fariselli L
Division of Radiotherapy, Fondazione Istituto Neurologico C. Besta, and Centro Diagnostico Italiano, Milan, Italy.
Marras C
No affiliation info available
De Santis M
No affiliation info available
Marchetti M
No affiliation info available
Milanesi I
No affiliation info available
Broggi G
No affiliation info available

MeSH

AgedAged, 80 and overFacial PainFemaleHumansMagnetic Resonance ImagingMaleMiddle AgedParesthesiaRadiosurgeryRadiotherapy DosageRadiotherapy Planning, Computer-AssistedTongueTreatment OutcomeTrigeminal Neuralgia

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

19165081

Clinical Trial Links

Non-invasive Ablation of Ventricular Tachycardia
Stereotactic Non-invasive Ablation of Ventricular Tachycardia

Citation

Fariselli, Laura, et al. "CyberKnife Radiosurgery as a First Treatment for Idiopathic Trigeminal Neuralgia." Neurosurgery, vol. 64, no. 2 Suppl, 2009, pp. A96-101.
Fariselli L, Marras C, De Santis M, et al. CyberKnife radiosurgery as a first treatment for idiopathic trigeminal neuralgia. Neurosurgery. 2009;64(2 Suppl):A96-101.
Fariselli, L., Marras, C., De Santis, M., Marchetti, M., Milanesi, I., & Broggi, G. (2009). CyberKnife radiosurgery as a first treatment for idiopathic trigeminal neuralgia. Neurosurgery, 64(2 Suppl), A96-101. https://doi.org/10.1227/01.NEU.0000341714.55023.8F
Fariselli L, et al. CyberKnife Radiosurgery as a First Treatment for Idiopathic Trigeminal Neuralgia. Neurosurgery. 2009;64(2 Suppl):A96-101. PubMed PMID: 19165081.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - CyberKnife radiosurgery as a first treatment for idiopathic trigeminal neuralgia. AU - Fariselli,Laura, AU - Marras,Carlo, AU - De Santis,Michela, AU - Marchetti,Marcello, AU - Milanesi,Ida, AU - Broggi,Giovanni, PY - 2009/1/24/entrez PY - 2009/1/30/pubmed PY - 2009/3/19/medline SP - A96 EP - 101 JF - Neurosurgery JO - Neurosurgery VL - 64 IS - 2 Suppl N2 - OBJECTIVE: To report the level of effectiveness and safety, in our experience, of CyberKnife (Accuray, Inc., Sunnyvale, CA) robotic radiosurgery as a first-line treatment against pharmacologically refractory trigeminal neuralgia. METHODS: We treated 33 patients with the frameless CyberKnife system as a monotherapy. The retrogasserian portion of the trigeminal nerve (a length of 4 mm, 2-3 mm anterior to the root entry zone) was targeted. Doses of 55 to 75 Gy were prescribed to the 100% isodose line, according to a dose escalation protocol. The patients were evaluated for the level of pain control, time to pain relief, hypesthesia, and time to pain recurrence. RESULTS: The median age was 74 years. All but 2 patients (94%) achieved a successful treatment outcome. The follow-up period was 9 to 37 months (mean, 23 months). The Barrow Neurological Institute Pain Intensity Scale (BPS) score before radiosurgery was III in 2 patients (6%), IV in 8 patients (24%), and V in 23 patients (70%). The time to pain relief was 1 to 180 days (median, 30 days). No facial numbness was observed. Only 1 patient developed a transitory dysesthesia of the tongue. After treatment, the BPS score was I, II, or III in 31 patients (97%). Pain recurred in 33% (11 patients) at a mean of 9 months (range, 1-43 months). Three patients with recurrences had low pain control by medication (BPS score, IV), and 1 patient (BPS score, V) needed a radiofrequency lesioning (BPS score, I at 12 months). CONCLUSION: CyberKnife radiosurgery for trigeminal neuralgia allows pain relief at safe doses and is suggested for pharmacologically refractory trigeminal neuralgia. Higher prescribed doses were not associated with improvement in pain relief or recurrence rate. SN - 1524-4040 UR - https://www.unboundmedicine.com/medline/citation/19165081/CyberKnife_radiosurgery_as_a_first_treatment_for_idiopathic_trigeminal_neuralgia_ L2 - https://academic.oup.com/neurosurgery/article-lookup/doi/10.1227/01.NEU.0000341714.55023.8F DB - PRIME DP - Unbound Medicine ER -