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 Rain 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 radiofre-quency 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.
| Original language | English |
|---|---|
| Journal | Neurosurgery |
| Volume | 64 |
| Issue number | 2 SUPPL. |
| DOIs | |
| Publication status | Published - Feb 2009 |
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Keywords
- Cyberknife
- Racial pain
- Radiosurgical rhizotomy
- Stereotactic radiosurgery
- Trigeminal neuralgia
ASJC Scopus subject areas
- Clinical Neurology
- Surgery
Cite this
CyberKnife radiosurgery as a first treatment for idiopathic trigeminal neuralgia. / Fariselli, Laura; Marras, Carlo; De Santis, Michela; Marchetti, Marcello; Milanesi, Ida; Broggi, Giovanni.
In: Neurosurgery, Vol. 64, No. 2 SUPPL., 02.2009.Research output: Contribution to journal › Article
}
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 - 2009/2
Y1 - 2009/2
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 Rain 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 radiofre-quency 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.
AB - 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 Rain 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 radiofre-quency 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.
KW - Cyberknife
KW - Racial pain
KW - Radiosurgical rhizotomy
KW - Stereotactic radiosurgery
KW - Trigeminal neuralgia
UR - http://www.scopus.com/inward/record.url?scp=61449266529&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=61449266529&partnerID=8YFLogxK
U2 - 10.1227/01.NEU.0000341714.55023.8F
DO - 10.1227/01.NEU.0000341714.55023.8F
M3 - Article
C2 - 19165081
AN - SCOPUS:61449266529
VL - 64
JO - Neurosurgery
JF - Neurosurgery
SN - 0148-396X
IS - 2 SUPPL.
ER -