Cyberknife radiosurgery for trigeminal neuralgia treatment: a preliminary multicenter experience.
OBJECTIVE
Radiosurgery has gained acceptance as a treatment option for trigeminal neuralgia. We report our preliminary multicenter experience treating trigeminal neuralgia with the CyberKnife (Accuray, Inc., Sunnyvale, CA).


METHODS
A total of 95 patients were treated for idiopathic trigeminal neuralgia between May 2002 and October 2005. Radiosurgical dose and volume parameters were retrospectively analyzed in relation to pain response, complications, and recurrence of symptoms. Optimal treatment parameters were identified for patients who had excellent and sustained pain relief with no complications, including severe or moderate hypesthesia.


RESULTS
Excellent pain relief was initially experienced by 64 out of 95 patients (67%). The median time to pain relief was 14 days (range, 0.3-180 d). Posttreatment numbness occurred in 45 (47%) of the patients treated. Using higher radiation doses and treating longer segments of the nerve led to both better pain relief and a higher incidence of hypesthesia. The presence of posttreatment numbness was predictive of better pain relief. The overall rate of complications was 18%. At the mean follow-up time of 2 years, 47 of the 95 patients (50%) had sustained pain relief, all of whom were completely off pain medications.


CONCLUSIONS
The results of this study suggest the following optimal radiosurgical treatment parameters for treatment of idiopathic trigeminal neuralgia: a median maximal dose of 78 Gy (range, 70-85.4 Gy) and a median length of the nerve treated of 6 mm (range, 5-12 mm).
Villavicencio
Alan T
AT
Boulder Neurosurgical Associates, Boulder, Colorado 80304, USA. atv@bnasurg.com
Lim
Michael
M
Burneikiene
Sigita
S
Romanelli
Pantaleo
P
Adler
John R
JR
McNeely
Lee
L
Chang
Steven D
SD
Fariselli
Laura
L
McIntyre
Melinda
M
Bower
Regina
R
Broggi
Giovanni
G
Thramann
Jeffrey J
JJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D010865:Pilot Projects; D016634:Radiosurgery / Q000379:methods*; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000150:complications / Q000601:surgery*