BACKGROUND: Medically refractory trigeminal neuralgia (TN) has been treated with a variety of minimally invasive techniques including radiosurgical rhizotomy. Clinical studies showed that radiosurgical procedures are safe and effective for patients not considered good surgical candidates. We present our preliminary experience on 13 cases of medically refractory TN treated only by Frameless Cyberknife System. MATERIALS AND METHODS: Between September 2004 and July 2005, 23 patients underwent radiosurgical rhizotomy with frameless Cyberknife. Thirteen out of 23 did not undergo previous surgical procedures and were included in the study. CT and MR were used to target the retrogasserian portion of the trigeminal nerve for a length of 4 mm. Radiation doses of 55- 75 Gy prescribed to the 80% isodose using a 5 mm collimator were administrated; the marginal doses ranged between 35 and 63 Gy (median 60). Patients were evaluated for the level of pain control by the Barrow Pain Scale, time to pain relief, occurrence of hypoesthesia, and time to pain recurrence. RESULTS: The median age at the treatment was 74 years, and the mean numbers of years with TN was 8 years (range 1-20). All patients had, before radiosurgery, a Barrow Pain Scale of 4 or 5. The median follow up time ranged between 15 and 30 months (mean 22.6). All but one patient (92.3%) achieved a successful treatment outcome. Barrow Pain Scale before radiosurgery was IV in 4 patients (30.7%); V in 9 patients (69.3%). The median time to pain relief was around 3 weeks. After radiosurgery facial numbness was not observed. After radio-surgery Barrow Pain Scale was I, II or III in 11 patients (84.6%). Pain recurrence was experienced in 30.7% of cases (4 patients). Recurrence was observed after a mean time of 7.5 months (range 2-14). CONCLUSIONS: Cyberknife radiosurgery for TN allows pain relief at safe doses and is suggested for medically refractory TN. Higher prescribed doses were not associated with improvement in pain relief or recurrence rate.
|Translated title of the contribution||Cyberknife radiosurgery as a first treatment for idiopathic trigeminal neuralgia: A preliminary experience|
|Number of pages||8|
|Publication status||Published - Mar 2007|
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