Linear accelerator thalamotomy.
BACKGROUND
The capability of performing functional radiosurgery lesions in the brain using a dedicated linear accelerator (LINAC) have not yet been demonstrated. This study evaluates modern LINAC technology for the creation of a sharp, small and functionally eloquent lesion in the thalamus.


METHODS
Three patients underwent thalamotomy using a dedicated linear accelerator to radiosurgery, 2 females and 1 male, ages were 52, 53, and 73 years. Two patients presented with unilateral poststroke central pain and 1 with unilateral upper extremity pain secondary to metastatic infiltration of the brachial plexus. Maximal doses varied from 150 to 200 Gy, delivered by a 5-mm diameter collimator and 5 to 8 noncoplanar arcs evenly distributed.


RESULTS
All patients gained substantial relief of their pain. They were able to reduce their medications and improve their activity levels. The patient with end-stage metastatic disease died of his malignancy 2 weeks after the treatment. One patient presented with recurrence of the pain 4 months after the treatment. No clinical complications were noticed.


CONCLUSIONS
A dedicated linear accelerator is able to perform a precise and circumscribed lesion in the thalamus for pain control. Moreover, it proved to be safe, because no complications were observed. For patients using chronic anticoagulant therapy or with severe disabilities caused by cardiac, pulmonary or malignant diseases, this technique represents an alternative of treatment to radiofrequency thalamotomy.
Frighetto
Leonardo
L
Division of Neurosurgery, School of Medicine, University of California-Los Angeles Medical Center, 200 UCLA Medical Plaza, Los Angeles, CA 90095-7182, USA.
De Salles
Antonio
A
Wallace
Robert
R
Ford
Judith
J
Selch
Michael
M
Cabatan-Awang
Cynthia
C
Solberg
Timothy
T
D000368:Aged; D001132:Arm; D001917:Brachial Plexus; D018288:Carcinoma, Small Cell / Q000150:complications / Q000556:secondary; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000150:complications; D010146:Pain / Q000209:etiology / Q000601:surgery; D010166:Palliative Care; D010315:Particle Accelerators; D010524:Peripheral Nervous System Neoplasms / Q000150:complications / Q000556:secondary; D016634:Radiosurgery; D013238:Stereotaxic Techniques; D020521:Stroke / Q000150:complications; D013788:Thalamus / Q000473:pathology / Q000601:surgery*