Dedicated linear accelerator radiosurgery for the treatment of trigeminal neuralgia.
OBJECTIVE
In this study the authors evaluate the efficacy of and complications associated with dedicated linear accelerator (LINAC) radiosurgery for trigeminal neuralgia (TN).


METHODS
Between August 1995 and February 2001, 60 patients whose median age was 66.1 years (range 45-88 years) were treated with dedicated LINAC radiosurgery for TN. Forty-one patients (68.3%) had essential TN, 12 (20%) had secondary facial pain, and seven (11.7%) had atypical features. Twenty-nine patients (48.3%) had undergone previous surgical procedures. Radiation doses varied between 70 and 90 Gy (mean 83.3 Gy) at the isocenter, with the last 35 patients (58.3%) treated with a 90-Gy dose. A 5-mm collimator was used in 45 patients (75%) and a 7.5-mm collimator in 15 patients (25%). Treatment was focused at the nerve root entry zone. At last follow up (mean follow-up period 23 months, range 2-70 months), 36 (87.8%) of the 41 patients with essential TN had sustained significant pain relief (good plus excellent results). Twenty-three patients (56.1%) were pain free without medication (excellent outcome), 13 (31.7%) had a 50 to 90% reduction in pain with or without medication (good outcome), and five (12.2%) had minor improvement or no relief. Of 12 patients with secondary facial pain, significant relief was sustained in seven patients (58.3%); worse results were found with atypical pain. Fifteen (25%) of the 60 patients experienced new numbness postprocedure; no other significant complications were found. Pain relief was experienced at a mean of 2.7 months (range 0-12 months).


CONCLUSIONS
Dedicated LINAC radiosurgery is a precise and effective treatment for TN.
Smith
Zachary A
ZA
Division of Neurosurgery, David Geffen School of Medicine, University of California at Los Angeles Medical Center, Los Angeles, California, USA.
De Salles
Antonio A F
AA
Frighetto
Leonardo
L
Goss
Bryan
B
Lee
Steve P
SP
Selch
Michael
M
Wallace
Robert E
RE
Cabatan-Awang
Cynthia
C
Solberg
Timothy
T
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods*; D012008:Recurrence; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000601:surgery*