Linear Accelerator-Based Frameless Stereotactic Radiosurgery for Trigeminal Neuralgia with Optical Surface Monitoring: A Community Cancer Center Experience

Chou, B.; Choe, Jun Ho; Park, H.; Mehl, C.; Bentley, Eri Suzuki; Jones, Guy C.

doi:10.1016/j.ijrobp.2018.07.1255

Cited by 2 publications

(8 citation statements)

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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%

“…[ 15 ] SRS was initially delivered to patients using a rigid head fixation through a bolted invasive device. [ 5 , 9 , 12 , 15 , 16 ] The frameless SRS system received a U.S. patent in 1995 and was clinically introduced in 1997. [ 27 , 32 ] The frameless SRS, comprised of a thermoplastic mask fitted to each patient, offers more patient comfort with minimal toxicities and without incisions or anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…Most of these patients had a good or excellent response (BNI-III) to frameless LINAC SRS, with percentages of patients ranging from 69% to 100%. Minimal side effects were reported in these studies, including a temporary pain flare,[ 5 ] fatigue,[ 5 ] new hypoesthesia,[ 4 ] and ipsilateral facial numbness. [ 9 ] Two of these studies included patients who underwent either frame-based or frameless LINAC.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

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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“…4,5 TGN has been treated at TCCC using a 5-mm diameter, stereotactic cone for prescriptions of 70-90 Gy to the maximum dose in a single fraction. 6 Treatment is delivered with a 6-MV FFF beam to the root of the affected trigeminal nerve using five non-coplanar,parasagittal arcs.To date,53 patients have been treated at TCCC for TGN using this method.…”

Section: Introductionmentioning

confidence: 99%

“…The AlignRT system has demonstrated sub‐millimeter precision for non‐coplanar SRS treatments 4,5 . TGN has been treated at TCCC using a 5‐mm diameter, stereotactic cone for prescriptions of 70–90 Gy to the maximum dose in a single fraction 6 . Treatment is delivered with a 6‐MV FFF beam to the root of the affected trigeminal nerve using five non‐coplanar, parasagittal arcs.…”

Section: Introductionmentioning

confidence: 99%

Commissioning a multileaf collimator virtual cone for the stereotactic radiosurgery of trigeminal neuralgia

Brown¹,

Ayers²,

Popple

2022

J Applied Clin Med Phys

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A multileaf collimator (MLC), virtual‐cone treatment technique has been commissioned for trigeminal neuralgia (TGN) at Tri‐Cities Cancer Center (TCCC). This novel technique was initially developed at the University of Alabama in Birmingham (UAB); it is designed to produce a spherical dose profile similar to a fixed, 5‐mm conical collimator distribution. Treatment is delivered with a 10‐MV flattening‐filter‐free (FFF) beam using a high‐definition MLC on a Varian Edge linear accelerator. Absolute dose output and profile measurements were performed in a 20 × 20 × 14 cm3 solid‐water phantom using an Exradin W2 scintillation detector and Gafchromic EBT3 film. Dose output constancy for the virtual cone was evaluated over 6 months using an Exradin A11 parallel plate chamber. The photo‐neutron dose generated by these treatments was assessed at distances of 50 and 100 cm from isocenter using a Ludlum Model 30–7 Series Neutron Meter. TGN treatments at TCCC have been previously delivered at 6‐MV FFF using a 5‐mm stereotactic cone. To assess the dosimetric impact of using a virtual cone, eight patients previously treated for TGN with a 5‐mm cone were re‐planned using a virtual cone. Seven patients have now been treated for TGN using a virtual cone at TCCC. Patient‐specific quality assurance was performed for each patient using Gafchromic EBT‐XD film inside a Standard Imaging Stereotactic Dose Verification Phantom. The commissioning results demonstrate that the virtual‐cone dosimetry, first described at UAB, is reproducible on a second Edge linear accelerator at an independent clinical site. The virtual cone is a credible alternative to a physical, stereotactic cone for the treatment of TGN at TCCC.

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Linear Accelerator-Based Frameless Stereotactic Radiosurgery for Trigeminal Neuralgia with Optical Surface Monitoring: A Community Cancer Center Experience

Cited by 2 publications

References 0 publications

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

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

Commissioning a multileaf collimator virtual cone for the stereotactic radiosurgery of trigeminal neuralgia

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