title: Cyberknife radiosurgery for trigeminal neuralgia treatment: a preliminary multicenter experience.
abstract: 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).
authors.affiliation: Boulder Neurosurgical Associates, Boulder, Colorado 80304, USA. atv@bnasurg.com
authors.forename: Alan T
authors.initials: AT
authors.lastname: Villavicencio
authors.forename: Michael
authors.initials: M
authors.lastname: Lim
authors.forename: Sigita
authors.initials: S
authors.lastname: Burneikiene
authors.forename: Pantaleo
authors.initials: P
authors.lastname: Romanelli
authors.forename: John R
authors.initials: JR
authors.lastname: Adler
authors.forename: Lee
authors.initials: L
authors.lastname: McNeely
authors.forename: Steven D
authors.initials: SD
authors.lastname: Chang
authors.forename: Laura
authors.initials: L
authors.lastname: Fariselli
authors.forename: Melinda
authors.initials: M
authors.lastname: McIntyre
authors.forename: Regina
authors.initials: R
authors.lastname: Bower
authors.forename: Giovanni
authors.initials: G
authors.lastname: Broggi
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Thramann
mesh_terms: 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*