Frameless image-guided radiosurgery for trigeminal neuralgia

Shields, Lisa B. E.; Shanks, Todd; Shearer, Andrew; Shelton, Lauren; Shelton, Brent J.; Howe, J; Coons, James M; Plato, Brian M.; Spalding, Aaron C.

doi:10.4103/2152-7806.207119

Cited by 9 publications

(8 citation statements)

References 36 publications

(47 reference statements)

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“…A recent report of 138 cases using the CyberKnife for initial treatment of trigeminal neuralgia with a mean dose of 75 Gy had an effective pain control rate (BNI class I-IIIa) at six months of 93.5%, 12 months 85.8%, 24 months 79.7%, and at 36 months 76% [ 15 ]. As both clinical experience and the planning software and computer movement controls of these CK or LINAC systems have improved, the results for initial treatment of trigeminal neuralgia using equivalent dosing and targets are almost similar to the much larger reported GK experience [ 21 - 23 ]. As treatment teams, including the neurosurgeon, radiation oncologist, and radiation physicist, became more familiar with the treatment target and dose for trigeminal neuralgia, there are reports using different non-isocentric LINAC systems for the initial treatment of trigeminal neuralgia that match that achieved with both GK and CK [ 22 - 27 ].…”

Section: Introductionmentioning

confidence: 57%

Evaluation of CyberKnife Radiosurgery for Recurrent Trigeminal Neuralgia

Berti¹,

Ibars²,

Wu³

et al. 2018

Cureus

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Stereotactic radiosurgery (SRS) has evolved as an accepted treatment for medication resistant trigeminal neuralgia. Initial results are very good but follow-up over three to five years shows a gradual return of pain in up to 50% of treated patients, often requiring further treatment. The results with repeat SRS using the isocentric Gamma Knife (GK) (Elekta, Stockholm, Sweden), especially in patients having initially good results, are very similar to the outcomes after the initial treatment although there is an increased risk of residual facial numbness secondary to the additional radiation dose to the trigeminal nerve. However, after 2000, non-isocentric SRS systems began to be used for treating trigeminal neuralgia including the CyberKnife (CK) (Accuray, Sunnyvale, California) as well as various linear accelerator (LINAC) based systems. This report specifically examines a series of recurrent trigeminal cases treated by the same group of physicians with the CK system. Similar doses and locations on the trigeminal nerve and/or the root entry zone were used for both initial and repeat SRS treatment regardless of system used. Although there are numerous series reporting the use of GK for recurrent treatment for recurrent trigeminal neuralgia, there are no series reviewing the results and long-term effectiveness using CK for repeat SRS for recurrent trigeminal pain. We reviewed 23 cases that had initial treatment for trigeminal neuralgia either surgically or with SRS with either the GK or CK and then a later second procedure only with CK. The follow-up after the second CK SRS ranged from three to 13 years found that the results are very similar to the multiple reports in the literature describing second or third SRS treatments with the GK. Results of repeat radiosurgery treatment of recurrent trigeminal neuralgia appear to be independent of the system used and are primarily based on proper target and dose to the trigeminal nerve.

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Section: Introductionmentioning

confidence: 57%

Evaluation of CyberKnife Radiosurgery for Recurrent Trigeminal Neuralgia

Berti¹,

Ibars²,

Wu³

et al. 2018

Cureus

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“…SRS is a viable option for patients who do not attain durable pain relief from medications or who do not want or are not candidates for invasive surgery. [ 22 ] Gamma Knife,[ 2 , 25 , 29 ] CyberKnife,[ 5 , 6 , 29 ] and LINAC[ 4 , 5 , 8 - 10 , 14 , 24 , 26 , 29 ] are several modalities of SRS that are tolerable and efficacious for treating medically resistant TN. Leksell introduced the stereotactic method in 1951[ 16 ] and subsequently reported its use for patients with TN in 1971.…”

Section: Discussionmentioning

confidence: 99%

“…The immobilization, simulation, treatment planning, and SRS delivery methodology were previously published. [ 26 ] Patients were treated with 80, 85, or 90 Gy with a mode of 85 Gy. The dose was prescribed to a point in the trigeminal nerve so that at least the 60–80% isodose line encompassed the nerve.…”

Section: Methodsmentioning

confidence: 99%

“…In our previous study of 20 patients who underwent frameless image-guided radiosurgery (IGRS) for refractory TN,[ 26 ] we demonstrated that this technique was an effective and noninvasive method of treating older individuals who were unresponsive to medical management. In addition to the small slice thickness of 0.6 mm that provided increased resolution at the target, mapping of the patient’s movement during treatment confirmed the benefit of using IGRS.…”

Section: Introductionmentioning

confidence: 99%

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Frameless image-guided linear accelerator (LINAC) stereotactic radiosurgery for medically refractory trigeminal neuralgia: Clinical outcomes in 116 patients

Shields,

Malkawi,

Daniels

et al. 2024

Surgical Neurology International

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Background: Frameless image-guided radiosurgery (IGRS) is an effective and non-invasive method of treating patients who are unresponsive to medical management for trigeminal neuralgia (TN). This study evaluated the use of frameless IGRS to treat patients with medically refractory TN. Methods: We performed a retrospective review of records of 116 patients diagnosed with TN who underwent frameless IGRS using a linear accelerator (LINAC) over 10 years (March 2012-February 2023). All patients had failed medical management for TN. Facial pain was graded using the Barrow Neurological Institute (BNI) scoring system. Each patient received a BNI score before frameless IGRS and following treatment. Failure was defined as a BNI score IV-V at the last follow-up and/or undergoing a salvage procedure following IGRS. Results: All patients had a BNI score of either IV or V before the frameless IGRS. The mean follow-up duration for all 116 patients following IGRS was 44.1 months. Most patients (81 [69.8%]) had not undergone surgery (microvascular decompression [MVD] or rhizotomy) or stereotactic radiosurgery (SRS) for TN before frameless IGRS. A total of 41 (35.3%) patients underwent a salvage procedure (MVD, rhizotomy, or an additional IGRS) following frameless IGRS. The mean duration between the initial frameless IGRS and salvage procedure was 20.1 months. At the last follow-up, a total of 110 (94.8%) patients had a BNI score of I-III. No complications were reported after the frameless IGRS. The BNI score at the last follow-up was lower compared to the initial BNI for patients regardless of prior intervention (P < 0.001). Patients who failed IGRS had a higher BNI score at the last follow-up compared to those who did not fail IGRS (2.8 vs. 2.5, P = 0.05). Patients with pain relief had a shorter follow-up compared to those with pain refractory to SRS (38.0 vs. 55.1, P = 0.005). Conclusion: In this large cohort of patients with medically refractory TN, frameless IGRS resulted in durable pain control in the majority of patients without any toxicity.

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“…Thus, verification imaging ensures that the patient is correctly aligned before treatment proceeds. While there are many reports in the literature discussing both frameless localization accuracy and intra-fraction motion [5][6][7][8], there has not been a detailed study of the correction threshold value used and its effect on treatment time and overall treatment uncertainty. The aim of the current study is to analyze the position data obtained from our TN treatments and evaluate the threshold value used for repositioning with respect to alignment uncertainty and positional correction frequency.…”

Section: Introductionmentioning

confidence: 99%

Intra-Fraction Motion Management for Radiosurgical Treatments of Trigeminal Neuralgia: Clinical Experience, Imaging Frequency, and Motion Analysis

Agazaryan¹,

Tenn²,

Pouratian³

et al. 2021

Cureus

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The aim of this study is to evaluate the patient positioning and intra-fraction motion management performance of an image-guidance protocol established for radiosurgical treatments of trigeminal neuralgia patients. Specifically, it also aims to analyze patient motion data for the evaluation of current motion tolerance levels and imaging frequency utilized for repositioning patients. MethodsA linear accelerator equipped with ExacTrac is used for patient positioning with stereoscopic imaging and treatments. Treatments are delivered with 4-mm conical collimators using seven equally spaced arcs. Arcs are 20 degrees apart and span 100 arc degrees each. Following initial ExacTrac positioning, cone beam computed tomography (CBCT) is obtained for independent confirmation of patient position. Patients are then stereoscopically imaged prior to the delivery of each arc and repositioned when 0.5-mm translational tolerance in any direction is exceeded. After the patient has been repositioned, verification stereoscopic images are obtained. Data from 48 patients with 607 image pairs were analyzed for this study. ResultsOver the course of 48 patient treatments, the mean magnitude of mean 3D deviations was 0.64 mm ± 0.12 mm (range: 0.07-2.74 mm). With the current 0.50-mm tolerance level for repositioning, patients exceeded the tolerance 51.4% of the time considering only images following an arc segment. For those instances, patients were repositioned with a mean magnitude of 0.85 mm ± 0.15 mm (1 SD). For a 0.25-mm tolerance level, 86.1% of arc segments would have required repositioning following the delivery of an arc segment, with a mean magnitude of 0.68 mm ± 0.12 mm. Conversely, for 0.75-mm and 1.00-mm tolerance levels, the tolerance would have been exceeded only 21.5% and 6.6% of instances following the delivery of an arc segment, with a mean magnitude of 1.08 mm ± 0.21 mm and 1.34 mm ± 0.24 mm, respectively. Each repositioning adds approximately 2 minutes to treatment time, which accounts for parts of the variability in patient treatment times. Following the initial ExacTrac and CBCT, the mean treatment time from first arc to treatment end was 57 minutes (range: 33-63 minutes).

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Frameless image-guided radiosurgery for trigeminal neuralgia

Cited by 9 publications

References 36 publications

Evaluation of CyberKnife Radiosurgery for Recurrent Trigeminal Neuralgia

Evaluation of CyberKnife Radiosurgery for Recurrent Trigeminal Neuralgia

Frameless image-guided linear accelerator (LINAC) stereotactic radiosurgery for medically refractory trigeminal neuralgia: Clinical outcomes in 116 patients

Intra-Fraction Motion Management for Radiosurgical Treatments of Trigeminal Neuralgia: Clinical Experience, Imaging Frequency, and Motion Analysis

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