Cyberknife Radiosurgery for Trigeminal Neuralgia Treatment

Villavicencio, Alan T.; Lim, Michael; Burneikienė, Sigita; Romanelli, Pantaleo; Adler, John R.; McNeely, Lee; Chang, Steven D.; Fariselli, Laura; McIntyre, Melinda; Bower, Regina S.; Broggi, Giovanni; Thramann, Jeffrey J.

doi:10.1227/01.neu.0000317313.46826.dc

Cited by 82 publications

(59 citation statements)

References 34 publications

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“…As has been mentioned, higher doses at individual treatments can yield better pain relief but with more sensory disturbance. 6,22,27,29,34,47,48 However, it may be that cumulative doses need to be much higher than reported here to produce dramatically higher rates of sensory disturbance.…”

Section: Trigeminal Sensory Dysfunction After Triple Gkrsmentioning

confidence: 66%

“…27 Villavicencio and colleagues reported an initial pain relief not requiring medication (BNI Scores I and II) in 67% of 95 patients who underwent first-time CyberKnife radiosurgery for medically refractory, idiopathic TN, 50% of whom maintained complete relief (> 90% pain relief) at 2 years after radiosurgery. 29,48 Rates of initial pain relief reported in the literature for single repeat GKRS in TN patients are similar. 1,9,13,16,18,19,24,34,36,45 In a large recent series, Park et al described their experience with repeat GKRS for recurrent TN in 119 patients at a median of 26 months after primary GKRS and noted that 87% of patients achieved initial pain relief (BNI Scores I-IIIb), 88% of whom maintained relief at 1 year, and 70% of whom maintained relief at 3 years after repeat GKRS.…”

Section: Repeat Gkrs For Tnmentioning

confidence: 72%

“…8,16,18,27 Kondziolka et al reported that 89% of their patients responded to treatment at a median of 1 month after initial GKRS; Villavicencio and colleagues observed a median time to pain relief of 2 weeks following initial CyberKnife radiosurgery. 27,29,48 There is consensus that those patients with the fewest alternate surgical treatments prior to initial radiosurgery tend to experience the shortest latency intervals to pain relief following radiosurgery. 27,29,34 Among patients undergoing single repeat GKRS, Park et al noted a median latency interval of 6 weeks, additionally hypothesizing that patients who experienced favorable responses to primary GKRS may experience shorted latency intervals after repeat GKRS.…”

Section: Repeat Gkrs For Tnmentioning

confidence: 99%

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The results of a third Gamma Knife procedure for recurrent trigeminal neuralgia

Tempel

Chivukula

Monaco

et al. 2015

JNS

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OBJECT Gamma Knife radiosurgery (GKRS) is the least invasive treatment option for medically refractory, intractable trigeminal neuralgia (TN) and is especially valuable for treating elderly, infirm patients or those on anticoagulation therapy. The authors reviewed pain outcomes and complications in TN patients who required 3 radiosurgical procedures for recurrent or persistent pain. METHODS A retrospective review of all patients who underwent 3 GKRS procedures for TN at 4 participating centers of the North American Gamma Knife Consortium from 1995 to 2012 was performed. The Barrow Neurological Institute (BNI) pain score was used to evaluate pain outcomes. RESULTS Seventeen patients were identified; 7 were male and 10 were female. The mean age at the time of last GKRS was 79.6 years (range 51.2–95.6 years). The TN was Type I in 16 patients and Type II in 1 patient. No patient suffered from multiple sclerosis. Eight patients (47.1%) reported initial complete pain relief (BNI Score I) following their third GKRS and 8 others (47.1%) experienced at least partial relief (BNI Scores II–IIIb). The average time to initial response was 2.9 months following the third GKRS. Although 3 patients (17.6%) developed new facial sensory dysfunction following primary GKRS and 2 patients (11.8%) experienced new or worsening sensory disturbance following the second GKRS, no patient sustained additional sensory disturbances after the third procedure. At a mean follow-up of 22.9 months following the third GKRS, 6 patients (35.3%) reported continued Score I complete pain relief, while 7 others (41.2%) reported pain improvement (BNI Scores II–IIIb). Four patients (23.5%) suffered recurrent TN following the third procedure at a mean interval of 19.1 months. CONCLUSIONS A third GKRS resulted in pain reduction with a low risk of additional complications in most patients with medically refractory and recurrent, intractable TN. In patients unsuitable for other microsurgical or percutaneous strategies, especially those receiving long-term oral anticoagulation or antiplatelet agents, GKRS repeated for a third time was a satisfactory, low risk option.

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Section: Trigeminal Sensory Dysfunction After Triple Gkrsmentioning

confidence: 66%

Section: Repeat Gkrs For Tnmentioning

confidence: 72%

Section: Repeat Gkrs For Tnmentioning

confidence: 99%

See 1 more Smart Citation

The results of a third Gamma Knife procedure for recurrent trigeminal neuralgia

Tempel

Chivukula

Monaco

et al. 2015

JNS

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“…Twenty-five percent of patients experienced new-onset numbness following linear accelerator radiosurgery. A more recent study by Villavicencio et al [25] studied the efficacy of Cyberknife radiosurgery for the treatment of TN. Initial pain relief occurred in 67% patients of whom 50% maintained pain relief at a mean follow-up of 2 years.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic Radiosurgery as Initial Surgical Management for Elderly Patients with Trigeminal Neuralgia

Cohen

Mousavi

Faraji

et al. 2017

Stereotact Funct Neurosurg

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Background: Management of older patients with medically refractory trigeminal neuralgia (TN) is yet a matter of debate. Objective: We sought to determine the benefit of stereotactic radiosurgery (SRS) as the sole surgical management in older patients (≥70 years). Methods: One hundred and twenty-seven patients (≥70 years) with typical TN underwent SRS as initial surgical management. The median maximum dose for the first procedure was 80 Gy. Repeat SRS was performed in 46 patients who developed recurrent pain. Results: After the first SRS, the initial pain control was achieved in 91% of patients. Complete pain relief (Barrow Neurological Institute [BNI] score I) developed in 75 patients (59%) and was maintained in 59, 39, and 22% of patients at 1, 3, and 5 years. Following repeat SRS, the rate of complete pain relief was 79, 55, and 41% at 1, 3, and 5 years. The chance of BNI I preservation was greater after repeat SRS compared to initial SRS (hazards ratio: 2.02, p < 0.0001). The incidence of trigeminal sensory loss was 17% after initial SRS but increased to 39% after repeat SRS. Conclusions: SRS alone was used effectively in older TN patients to achieve pain control. Recurrent pain responded to retreatment but was associated with an increased risk of sensory dysfunction.

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“…Dedicated radiosurgical devices, such as the Gamma Knife (Elekta AB, Stockolm, Sweden) or the CyberKnife (Accuray Inc., Sunnyvale, USA) as well as conventional linear accelerators (LINACs) equipped with radiosurgical accessories [5], have been successfully utilized to treat trigeminal neuralgia. Several reports document long-term pain relief after focal irradiation in 70-80% of patients through frame-based or frameless radiosurgery [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

What if you cannot see the target? Two case studies of atlas-to-patient registration in trigeminal neuralgia radiosurgery.

Stancanello¹,

Muacevic²

2010

Cureus

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Introduction: Medically resistant trigeminal neuralgia (TN) is a well-suited pathology to be treated by radiosurgery (RS). A significant percentage (60%-70%) of patients is expected to benefit from the RS treatment. Imaging is crucial to identify the target, though unfortunately in some cases the trigeminal nerve could not be visible even in high field magnetic resonance images (MRI). The aim of this work is to develop and relatively validate a method for the atlasbased identification of the target in those cases where the trigeminal nerve is not visible.

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Cyberknife Radiosurgery for Trigeminal Neuralgia Treatment

Abstract: The results of this study suggest the following optimal radiosurgical treatment parameters for treatment of idiopathic trigeminal neuralgia: a median maximal dose of 78 Gy (range, 70-85.4 Gy) and a median length of the nerve treated of 6 mm (range, 5-12 mm).

Cited by 82 publications

References 34 publications

The results of a third Gamma Knife procedure for recurrent trigeminal neuralgia

The results of a third Gamma Knife procedure for recurrent trigeminal neuralgia

Stereotactic Radiosurgery as Initial Surgical Management for Elderly Patients with Trigeminal Neuralgia

What if you cannot see the target? Two case studies of atlas-to-patient registration in trigeminal neuralgia radiosurgery.

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