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Frameless Stereotactic Radiosurgery for Treatment of Multiple Sclerosis-Related Trigeminal Neuralgia.
World Neurosurg. 2017 Jul; 103:702-712.WN

Abstract

BACKGROUND

Trigeminal neuralgia (TN) affects 7% of patients with multiple sclerosis (MS). In such patients, TN is difficult to manage either pharmacologically and surgically. Radiosurgical rhizotomy is an effective treatment option. The nonisocentric geometry of radiation beams of CyberKnife introduces new concepts in the treatment of TN. Its efficacy for MS-related TN has not yet been demonstrated.

METHODS

Twenty-seven patients with refractory TN and MS were treated. A nonisocentric beams distribution was chosen; the maximal target dose was 72.5 Gy. The maximal dose to the brainstem was <12 Gy. Effects on pain, medications, sensory disturbance, rate, and time of pain recurrence were analyzed.

RESULTS

Median follow-up was 37 (18-72) months. Barrow Neurological Institute pain scale score I-III was achieved in 23/27 patients (85%) within 45 days. Prescription isodose line (80%) accounting for a dose of 58 Gy incorporated an average of 4.85 mm (4-6 mm) of the nerve and mean nerve volume of 26.4 mm3 (range 20-38 mm3). Seven out of 27 patients (26%) had mild, not bothersome, facial numbness (Barrow Neurological Institute numbness score II). The rate of pain control decreased progressively after the first year, and only 44% of patients retained pain control 4 years later.

CONCLUSIONS

Frameless radiosurgery can be effectively used to perform retrogasserian rhizotomy. Pain relief was satisfactory and, with our dose/volume constraints, no sensory complications were recorded. Nonetheless, long-term pain control was possible in less than half of the patients. This is a limitation that CyberKnife radiosurgery shares with other techniques in MS patients.

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Authors+Show Affiliations

Conti A
Unit of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy. Electronic address: alfredo.conti@unime.it.
Pontoriero A
Unit of Radiation Oncology, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy.
Iatì G
Unit of Radiation Oncology, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy.
Esposito F
Unit of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy.
Siniscalchi EN
Unit of Maxillo-Facial Surgery, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy.
Crimi S
Unit of Maxillo-Facial Surgery, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy.
Vinci S
Unit of Neuroradiology, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy.
Brogna A
Unit of Medical Physics, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy.
De Ponte F
Unit of Maxillo-Facial Surgery, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy.
Germanò A
Unit of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy.
Pergolizzi S
Unit of Radiation Oncology, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy.
Tomasello F
Unit of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy.

MeSH

FemaleFollow-Up StudiesHumansMagnetic Resonance ImagingMaleMiddle AgedMultiple SclerosisRadiosurgeryRadiotherapy, Image-GuidedRhizotomyTomography, X-Ray ComputedTrigeminal NerveTrigeminal Neuralgia

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28454993

Citation

Conti, Alfredo, et al. "Frameless Stereotactic Radiosurgery for Treatment of Multiple Sclerosis-Related Trigeminal Neuralgia." World Neurosurgery, vol. 103, 2017, pp. 702-712.
Conti A, Pontoriero A, Iatì G, et al. Frameless Stereotactic Radiosurgery for Treatment of Multiple Sclerosis-Related Trigeminal Neuralgia. World Neurosurg. 2017;103:702-712.
Conti, A., Pontoriero, A., Iatì, G., Esposito, F., Siniscalchi, E. N., Crimi, S., Vinci, S., Brogna, A., De Ponte, F., Germanò, A., Pergolizzi, S., & Tomasello, F. (2017). Frameless Stereotactic Radiosurgery for Treatment of Multiple Sclerosis-Related Trigeminal Neuralgia. World Neurosurgery, 103, 702-712. https://doi.org/10.1016/j.wneu.2017.04.102
Conti A, et al. Frameless Stereotactic Radiosurgery for Treatment of Multiple Sclerosis-Related Trigeminal Neuralgia. World Neurosurg. 2017;103:702-712. PubMed PMID: 28454993.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Frameless Stereotactic Radiosurgery for Treatment of Multiple Sclerosis-Related Trigeminal Neuralgia. AU - Conti,Alfredo, AU - Pontoriero,Antonio, AU - Iatì,Giuseppe, AU - Esposito,Felice, AU - Siniscalchi,Enrico Nastro, AU - Crimi,Salvatore, AU - Vinci,Sergio, AU - Brogna,Anna, AU - De Ponte,Francesco, AU - Germanò,Antonino, AU - Pergolizzi,Stefano, AU - Tomasello,Francesco, Y1 - 2017/04/26/ PY - 2017/01/15/received PY - 2017/04/15/revised PY - 2017/04/17/accepted PY - 2017/4/30/pubmed PY - 2017/9/26/medline PY - 2017/4/30/entrez KW - CyberKnife KW - Facial numbness KW - Frameless radiosurgery KW - Multiple sclerosis KW - Stereotactic radiosurgery KW - Trigeminal neuralgia SP - 702 EP - 712 JF - World neurosurgery JO - World Neurosurg VL - 103 N2 - BACKGROUND: Trigeminal neuralgia (TN) affects 7% of patients with multiple sclerosis (MS). In such patients, TN is difficult to manage either pharmacologically and surgically. Radiosurgical rhizotomy is an effective treatment option. The nonisocentric geometry of radiation beams of CyberKnife introduces new concepts in the treatment of TN. Its efficacy for MS-related TN has not yet been demonstrated. METHODS: Twenty-seven patients with refractory TN and MS were treated. A nonisocentric beams distribution was chosen; the maximal target dose was 72.5 Gy. The maximal dose to the brainstem was <12 Gy. Effects on pain, medications, sensory disturbance, rate, and time of pain recurrence were analyzed. RESULTS: Median follow-up was 37 (18-72) months. Barrow Neurological Institute pain scale score I-III was achieved in 23/27 patients (85%) within 45 days. Prescription isodose line (80%) accounting for a dose of 58 Gy incorporated an average of 4.85 mm (4-6 mm) of the nerve and mean nerve volume of 26.4 mm3 (range 20-38 mm3). Seven out of 27 patients (26%) had mild, not bothersome, facial numbness (Barrow Neurological Institute numbness score II). The rate of pain control decreased progressively after the first year, and only 44% of patients retained pain control 4 years later. CONCLUSIONS: Frameless radiosurgery can be effectively used to perform retrogasserian rhizotomy. Pain relief was satisfactory and, with our dose/volume constraints, no sensory complications were recorded. Nonetheless, long-term pain control was possible in less than half of the patients. This is a limitation that CyberKnife radiosurgery shares with other techniques in MS patients. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/28454993/Frameless_Stereotactic_Radiosurgery_for_Treatment_of_Multiple_Sclerosis_Related_Trigeminal_Neuralgia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(17)30610-1 DB - PRIME DP - Unbound Medicine ER -