title: CyberKnife radiosurgery for idiopathic trigeminal neuralgia.
abstract: OBJECTIVE
  Gamma knife surgery is an accepted treatment option for trigeminal neuralgia (TN). The safety and efficacy of CyberKnife radiosurgery as a treatment option for TN, however, has not been established.
  
  
  METHODS
  Forty-one patients were treated between May 2002 and September 2004 for idiopathic TN at Stanford University and the Rocky Mountain CyberKnife Center. Patients with atypical pain, multiple sclerosis, or previous radiosurgical treatment or a follow-up duration of less than 6 months were excluded. Patients were evaluated for the level of pain control, response rate, time to pain relief, occurrence of hypesthesia, and time to pain recurrence with respect to the length of the nerve treated and the maximum and the minimum dose to the nerve margin. Thirty-eight patients (92.7%) experienced initial pain relief at a median of 7 days after treatment (range, 24 hours-4 months). Pain control was ranked as excellent in 36 patients (87.8%), moderate in two (4.9%), and three (7.3%) reported no change. Six (15.8%) of the 38 patients with initial relief experienced a recurrence of pain at a median of 6 months (range 2-8 months). Long-term response after a mean follow-up time of 11 months was found in 32 (78%) of 41. Twenty-one patients (51.2%) experienced numbness after treatment.
  
  
  CONCLUSIONS
  CyberKnife radiosurgery for TN has high rates of initial pain control and short latency to pain relief compared with those reported for other radiosurgery systems. The doses used for treatment were safe and effective. Higher prescribed doses were not associated with improvement in pain relief or recurrence rate. The hypesthesia rate was related to the length of the trigeminal nerve treated.
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Lim
authors.forename: Alan T
authors.initials: AT
authors.lastname: Villavicencio
authors.forename: Sigita
authors.initials: S
authors.lastname: Burneikiene
authors.forename: Steven D
authors.initials: SD
authors.lastname: Chang
authors.forename: Pantaleo
authors.initials: P
authors.lastname: Romanelli
authors.forename: Lee
authors.initials: L
authors.lastname: McNeely
authors.forename: Melinda
authors.initials: M
authors.lastname: McIntyre
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Thramann
authors.forename: John R
authors.initials: JR
authors.lastname: Adler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000706:statistics & numerical data; D011446:Prospective Studies; D011859:Radiography; D016634:Radiosurgery / Q000295:instrumentation* / Q000379:methods / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014277:Trigeminal Neuralgia / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*