Treatment of trigeminal neuralgia with linear accelerator radiosurgery: initial results

被引:30
作者
Chen, JCT
Girvigian, M
Greathouse, H
Miller, M
Rahimian, J
机构
[1] Los Angeles Cty Med Ctr, Kaiser Permanente, Los Angeles, CA USA
[2] Univ So Calif, Dept Neurol Surg, Keck Sch Med, Los Angeles, CA USA
[3] Univ So Calif, Dept Radiat Oncol, Keck Sch Med, Los Angeles, CA USA
[4] Univ Calif Los Angeles, Div Med Phys, Los Angeles, CA USA
关键词
trigeminal neuralgia; tic douloureux; stereotactic radiosurgery; single isocenter; Novalis; linear accelerator; pain;
D O I
10.3171/sup.2004.101.supplement3.0346
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Object. Radiosurgery has emerged as an important treatment of trigeminal neuralgia. Substantial advantages have been demonstrated in safety and comfort over other modalities. Radiosurgical treatment of trigeminal neuralgia has been well investigated with gamma knife devices involving fixed cobalt sources. Few reports exist concerning trigeminal neuralgia treated using linear accelerator (LINAC)-based devices. In recent years these devices have reached the level of mechanical precision that is required for such functional treatments. The authors describe their initial experience with radiosurgical treatment of trigeminal neuralgia when using a BrainLAB Novalis LINAC device equipped with the commercially available 4-mm collimator. Methods. A total of 32 patients were treated in a 12-month period between November 2002 and November 2003. The median patient age was 67 years (range 38-84 years). Facial pain was graded using the Barrow Neurological Institute (BNI) scoring system; All patients' pain was BNI Grade IV or V prior to treatment. Of these patients, 22 were undergoing initial treatment, and 10 were undergoing retreatment for recurrent pain following various treatments including percutaneous procedures, gamma knife surgery (GKS), or microvascular decompression. Two patients had multiple sclerosis. In patients undergoing initial radiosurgery, the most proximal segment of the cisternal portion of the trigeminal nerve received 85 to 90 Gy administered in a 5- or 7-noncoplanar arc single-isocenter plan with a 4-mm circular collimator. In patients undergoing repeated radiosurgery, the target received 60 Gy. Overall good and excellent results (BNI Grade I, II, or III) were achieved in 25 (78%) of 32 patients. The median time to pain relief was 6 weeks. Fair results (improvement in pain with BNI Grade IV) were achieved in three patients (9%), and poor results (no improvement in pain and BNI Grade IV or V) were seen in four (13%). Two patients demonstrated new trigeminal dysfunction following treatment. No other complications occurred. Conclusions. High-precision imaging and LINAC instrumentation have allowed for treatment of trigeminal neuralgia with results and safety comparable to those achieved using GKS. Linear accelerator-based radiosurgery with the Novalis device is a safe and effective method of managing trigeminal neuralgia and may become the preferred means at centers where the technology is available.
引用
收藏
页码:346 / 350
页数:5
相关论文
共 35 条
[1]
MAGNETIC-RESONANCE IMAGE-DIRECTED STEREOTAXIC NEUROSURGERY - USE OF IMAGE FUSION WITH COMPUTERIZED-TOMOGRAPHY TO ENHANCE SPATIAL ACCURACY [J].
ALEXANDER, E ;
KOOY, HM ;
VANHERK, M ;
SCHWARTZ, M ;
BARNES, PD ;
TARBELL, N ;
MULKERN, RV ;
HOLUPKA, EJ ;
LOEFFLER, JS .
JOURNAL OF NEUROSURGERY, 1995, 83 (02) :271-276
[2]
The long-term outcome of microvascular decompression for trigeminal neuralgia [J].
Barker, FG ;
Jannetta, PJ ;
Bissonette, DJ ;
Larkins, MV ;
Jho, HD .
NEW ENGLAND JOURNAL OF MEDICINE, 1996, 334 (17) :1077-1083
[3]
Trigeminal numbness and tic relief after microvascular decompression for typical trigeminal neuralgia [J].
Barker, FG ;
Jannetta, PJ ;
Bissonette, DJ ;
Jho, HD .
NEUROSURGERY, 1997, 40 (01) :39-45
[4]
Gamma knife radiosurgery for primary management for trigeminal neuralgia [J].
Brisman, R .
JOURNAL OF NEUROSURGERY, 2000, 93 :159-161
[5]
LONG-TERM RESULTS OF PERCUTANEOUS RETROGASSERIAN THERMORHIZOTOMY FOR ESSENTIAL TRIGEMINAL NEURALGIA - CONSIDERATIONS IN 1000 CONSECUTIVE PATIENTS [J].
BROGGI, G ;
FRANZINI, A ;
LASIO, G ;
GIORGI, C ;
SERVELLO, D .
NEUROSURGERY, 1990, 26 (05) :783-787
[6]
Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases, including 10 patients with multiple sclerosis [J].
Broggi, G ;
Ferroli, P ;
Franzini, A ;
Servello, D ;
Dones, I .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 2000, 68 (01) :59-64
[7]
VARIABLES AFFECTING THE ACCURACY OF STEREOTAXIC LOCALIZATION USING COMPUTERIZED-TOMOGRAPHY [J].
BUCHOLZ, RD ;
HO, HW ;
RUBIN, JP .
JOURNAL OF NEUROSURGERY, 1993, 79 (05) :667-673
[8]
A new classification for facial pain [J].
Burchiel, KJ .
NEUROSURGERY, 2003, 53 (05) :1164-1166
[9]
LONG-TERM EFFICACY OF MICROVASCULAR DECOMPRESSION IN TRIGEMINAL NEURALGIA [J].
BURCHIEL, KJ ;
CLARKE, H ;
HAGLUND, M ;
LOESER, JD .
JOURNAL OF NEUROSURGERY, 1988, 69 (01) :35-38
[10]
Linear accelerator radiosurgery using 90 Gray for essential trigeminal neuralgia: Results and dose volume histogram analysis [J].
Goss, BW ;
Frighetto, L ;
DeSalles, AAF ;
Smith, Z ;
Solberg, T ;
Selch, M .
NEUROSURGERY, 2003, 53 (04) :823-828