Image-Guided Robotic Radiosurgery for Trigeminal Neuralgia

Romanelli, Pantaleo; Conti, Alfredo; Bianchi, Livia; Bergantin, A.; Martinotti, A.S.; Beltramo, G.

doi:10.1093/neuros/nyx571

Cited by 25 publications

(36 citation statements)

References 44 publications

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“…This is also the first report on the application of frameless robotic image-guided radiosurgery for HH. Frameless radiosurgery is a thoroughly non-invasive treatment offering submillimetric accuracy [ 10 ]. Furthermore, the absence of a stereotactic frame opens up a wide space for additional beam trajectories, thus enhancing the beam access to skull base or deep brain lesions.…”

Section: Discussionmentioning

confidence: 99%

“…CyberKnife radiosurgery system is an image-guided frameless device that delivers beams to the target in a non-isocentric fashion through a robotic linear accelerator (LINAC). CyberKnife radiosurgery provides the least invasive stereotactic radiosurgery modality available, with proven submillimetric accuracy despite the absence of a frame to immobilize the head [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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CyberKnife® Radiosurgery as First-line Treatment for Catastrophic Epilepsy Caused by Hypothalamic Hamartoma

Romanelli

2018

Cureus

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Hypothalamic hamartomas (HH) are deep-seated lesions often associated with catastrophic epilepsy (an epileptic syndrome characterized by severe, drug-refractory seizures eventually leading to mental retardation and death). Radical microsurgical resection is not feasible for lesions located within the wall of the third ventricle inside the hypothalamus. Frame-based stereotactic radiosurgery has been reported as an effective treatment modality for small- to medium-size intrahypothalamic hamartomas, providing excellent seizure outcomes without lasting complications. This report describes the use of frameless image-guided robotic radiosurgery (CyberKnife® Radiosurgery System) as a first-line treatment in two children with catastrophic epilepsy induced by HH. Both patients experienced multiple-daily complex partial and gelastic seizures, as well as almost daily generalized seizures. The prescribed dose was 16 Gy (to the 65% isodose for case I; to the 70% isodose for case II). Lesional volume was 11.5 cc (case I) and 8.9 cc (case II). A steady reduction of the seizure frequency and severity was achieved after the treatment, starting about three months after the treatment. The generalized seizures disappeared within one year, while complete resolution of the gelastic seizures required up to 18 months. No seizure recurrence and no radiation-induced side effects or complications were witnessed over a follow-up period of ten years and eight months (case I) and nine years and seven months (case II) since the treatment. CyberKnife radiosurgery proved to be a safe and effective non-invasive first-line treatment in these two children with catastrophic epilepsy caused by HH.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

CyberKnife® Radiosurgery as First-line Treatment for Catastrophic Epilepsy Caused by Hypothalamic Hamartoma

Romanelli

2018

Cureus

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“…Nonetheless, this technique is not always applicable due to a lack of neurovascular conflict, contraindications for major surgery, or patient preference. Alternative techniques aim to modulate the trigeminal nociceptive pathways either by percutaneous lesioning of the Gasserian ganglion or by irradiation of the cisternal portion of the nerve using stereotactic radiosurgery (SRS) [1,6,7]. Clinical experience regarding TN treatment using SRS is based mainly on single isocenter Gamma knife radiosurgery (GKS) treatments [8].…”

Section: Introductionmentioning

confidence: 99%

Factors affecting outcome in frameless non-isocentric stereotactic radiosurgery for trigeminal neuralgia: a multicentric cohort study

et al. 2020

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Background: Stereotactic radiosurgery (SRS) is an effective treatment for trigeminal neuralgia (TN). Nevertheless, a proportion of patients will experience recurrence and treatment-related sensory disturbances. In order to evaluate the predictors of efficacy and safety of image-guided non-isocentric radiosurgery, we analyzed the impact of trigeminal nerve volume and the nerve dose/volume relationship, together with relevant clinical characteristics. Methods: Two-hundred and ninety-six procedures were performed on 262 patients at three centers. In 17 patients the TN was secondary to multiple sclerosis (MS). Trigeminal pain and sensory disturbances were classified according to the Barrow Neurological Institute (BNI) scale. Pain-free-intervals were investigated using Kaplan Meier analyses. Univariate and multivariate Cox regression analyses were performed to identify predictors. Results: The median follow-up period was 38 months, median maximal dose 72.4 Gy, median target nerve volume 25 mm 3 , and median prescription dose 60 Gy. Pain control rate (BNI I-III) at 6, 12, 24, 36, 48, and 60 months were 96.8, 90.9, 84.2, 81.4, 74.2, and 71.2%, respectively. Overall, 18% of patients developed sensory disturbances. Patients with volume ≥ 30 mm 3 were more likely to maintain pain relief (p = 0.031), and low integral dose (< 1.4 mJ) tended to be associated with more pain recurrence than intermediate (1.4-2.7 mJ) or high integral dose (> 2.7 mJ; low vs. intermediate: log-rank test, χ 2 = 5.02, p = 0.019; low vs. high: log-rank test, χ 2 = 6.026, p = 0.014). MS, integral dose, and mean dose were the factors associated with pain recurrence, while re-irradiation and MS were predictors for sensory disturbance in the multivariate analysis.

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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: 56%

“…Detailed pre-treatment radiographic studies and mapping of the trigeminal nerve complex are critical in defining the precise target of the trigeminal nerve within the basal cisterns especially when using contrast enhancement and 3.0 Tesla imaging [ 44 ]. Treatment of recurrent pain after successful SRS with the GK has been extensively reported in the literature and a PubMed search found over 450 cases of repeat SRS with the GK but there are no specific reports of recurrent stereotactic radiotherapy using CK or LINAC based systems except for anecdotal mention within articles on treating trigeminal neuralgia [ 19 - 21 ]. The return of pain within the first year after SRS treatment has been classified either as immediate or short term failure.…”

Section: Reviewmentioning

confidence: 99%

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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Image-Guided Robotic Radiosurgery for Trigeminal Neuralgia

Cited by 25 publications

References 44 publications

CyberKnife® Radiosurgery as First-line Treatment for Catastrophic Epilepsy Caused by Hypothalamic Hamartoma

CyberKnife® Radiosurgery as First-line Treatment for Catastrophic Epilepsy Caused by Hypothalamic Hamartoma

Factors affecting outcome in frameless non-isocentric stereotactic radiosurgery for trigeminal neuralgia: a multicentric cohort study

Evaluation of CyberKnife Radiosurgery for Recurrent Trigeminal Neuralgia

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