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CyberKnife radiosurgery as a first treatment for idiopathic trigeminal neuralgia.

https://arctichealth.org/en/permalink/ahliterature152934
Source
Neurosurgery. 2009 Feb;64(2 Suppl):A96-101
Publication Type
Article
Date
Feb-2009
Author
Laura Fariselli
Carlo Marras
Michela De Santis
Marcello Marchetti
Ida Milanesi
Giovanni Broggi
Author Affiliation
Division of Radiotherapy, Fondazione Istituto Neurologico C. Besta, and Centro Diagnostico Italiano, Milan, Italy.
Source
Neurosurgery. 2009 Feb;64(2 Suppl):A96-101
Date
Feb-2009
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Facial Pain - etiology - surgery
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Paresthesia - etiology
Radiosurgery - adverse effects - methods
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted
Tongue - radiation effects
Treatment Outcome
Trigeminal Neuralgia - surgery
Abstract
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.
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.
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).
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.
PubMed ID
19165081 View in PubMed
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Gamma knife radiosurgery in the treatment of tumor-related facial pain.

https://arctichealth.org/en/permalink/ahliterature125188
Source
Stereotact Funct Neurosurg. 2012;90(3):145-50
Publication Type
Article
Date
2012
Author
Sarah E Squire
Michael D Chan
R Michael Furr
Dorothy A Lowell
Stephen B Tatter
Thomas L Ellis
J Daniel Bourland
Allan F Deguzman
Michael T Munley
Kenneth E Ekstrand
Edward G Shaw
Kevin P McMullen
Author Affiliation
Department of Radiation Oncology, Wake Forest University, Winston-Salem, NC, USA. sarahsquire@gmail.com
Source
Stereotact Funct Neurosurg. 2012;90(3):145-50
Date
2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Brain Neoplasms - complications - surgery
Facial Pain - etiology - surgery
Female
Follow-Up Studies
Humans
Male
Meningioma - complications - surgery
Middle Aged
Neurilemmoma - complications - surgery
Pain Measurement
Radiosurgery - instrumentation
Retrospective Studies
Treatment Outcome
Abstract
Intracranial neoplasms can cause pain similar to trigeminal neuralgia. Literature regarding radiosurgery for this is limited. We present a retrospective review of patients with tumor-related facial pain from benign lesions treated with gamma knife radiosurgery (GKRS) at Wake Forest University.
The primary objectives were to determine long-term pain relief and predictive factors for pain alleviation.
We reviewed 515 patients treated with GKRS for benign meningioma, vestibular schwannoma or trigeminal schwannoma between August 1999 and August 2010. Twenty-one eligible patients had tumor-related facial pain prior to GKRS. The median marginal tumor dose was 12 Gy. Long-term pain relief data were obtained by chart review and telephone interview.
The median follow-up for symptom evaluation was 3.8 years. Seventeen of 21 patients (81%) experienced a Barrow Neurological Institute (BNI) score of I-III at 6 months following GKRS. Kaplan-Meier estimates of freedom from BNI IV-V relapse were 66% at 1 year and 53% at 2 years. No pain relapses occurred after 2 years.
GKRS of benign lesions is a noninvasive option for patients with tumor-related facial pain. Pain relief is modest, with the majority of pain relapses occurring within 2 years and approximately one half of patients maintaining relief beyond 2 years.
PubMed ID
22508112 View in PubMed
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Predictive nomogram for the durability of pain relief from gamma knife radiation surgery in the treatment of trigeminal neuralgia.

https://arctichealth.org/en/permalink/ahliterature104782
Source
Int J Radiat Oncol Biol Phys. 2014 May 1;89(1):120-6
Publication Type
Article
Date
May-1-2014
Author
John T Lucas
Adrian M Nida
Scott Isom
Kopriva Marshall
John D Bourland
Adrian W Laxton
Stephen B Tatter
Michael D Chan
Author Affiliation
Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina. Electronic address: johnthomas75@gmail.com.
Source
Int J Radiat Oncol Biol Phys. 2014 May 1;89(1):120-6
Date
May-1-2014
Language
English
Publication Type
Article
Keywords
Aged
Facial Pain - etiology - surgery
Female
Humans
Male
Middle Aged
Nomograms
Pain Management - methods
Pain Measurement - methods
Pain, Postoperative - therapy
Proportional Hazards Models
Radiosurgery - methods
Radiotherapy Dosage
Recurrence
Retrospective Studies
Time Factors
Trigeminal Neuralgia - surgery
Abstract
To determine factors associated with the durability of stereotactic radiation surgery (SRS) for treatment of trigeminal neuralgia (TN).
Between 1999 and 2008, 446 of 777 patients with TN underwent SRS and had evaluable follow-up in our electronic medical records and phone interview records. The median follow-up was 21.2 months. The Barrow Neurologic Institute (BNI) pain scale was used to determine pre- and post-SRS pain. Dose-volume anatomical measurements, Burchiel pain subtype, pain quality, prior procedures, and medication usage were included in this retrospective cohort to identify factors impacting the time to BNI 4-5 pain relapse by using Cox proportional hazard regression. An internet-based nomogram was constructed based on predictive factors of durable relief pre- and posttreatment at 6-month intervals.
Rates of freedom from BNI 4-5 failure at 1, 3, and 5 years were 84.5%, 70.4%, and 46.9%, respectively. Pain relief was BNI 1-3 at 1, 3, and 5 years in 86.1%, 74.3%, and 51.3% of type 1 patients; 79.3%, 46.2%, and 29.3% of type 2 patients; and 62.7%, 50.2%, and 25% of atypical facial pain patients. BNI type 1 pain score was achieved at 1, 3, and 5 years in 62.9%, 43.5%, and 22.0% of patients with type 1 pain and in 47.5%, 25.2%, and 9.2% of type 2 patients, respectively. Only 13% of patients with atypical facial pain achieved BNI 1 response; 42% of patients developed post-Gamma Knife radiation surgery (GKRS) trigeminal dysfunction. Multivariate analysis revealed that post-SRS numbness (hazard ratio [HR], 0.47; P
PubMed ID
24613811 View in PubMed
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