title: Dedicated linear accelerator radiosurgery for trigeminal neuralgia: a single-center experience in 179 patients with varied dose prescriptions and treatment plans.
abstract: OBJECTIVE
  Dedicated linear accelerator radiosurgery (D-LINAC) has become an important treatment for trigeminal neuralgia (TN). Although the use of gamma knife continues to be established, few large series exist using D-LINAC. The authors describe their results, comparing the effects of varied target and dose regimens.
  
  
  METHODS
  Between August 1995 and January 2008, 179 patients were treated with D-LINAC radiosurgery. Ten patients (5.58%) had no clinical follow-up. The median age was 74.0 years (range, 32-90 years). A total of 39 patients had secondary or atypical pain, and 130 had idiopathic TN. Initially, 28 patients received doses between 70 and 85 Gy, with the 30% isodose line (IDL) touching the brainstem. Then, using 90 Gy, 82 consecutive patients were treated with a 30% IDL and 59 patients with a 50% IDL tangential to the pons.
  
  
  RESULTS
  Of 169 patients, 134 (79.3%) experienced significant relief at a mean of 28.8 months (range, 5-142 months). Average time to relief was 1.92 months (range, immediate to 6 months). A total of 31 patients (19.0%) had recurrent pain at 13.5 months. Of 87 patients with idiopathic TN without prior procedures, 79 (90.8%) had initial relief. Among 28 patients treated with 70 Gy and 30% IDL, 18 patients (64.3%) had significant relief, and 10 (35.7%) had numbness. Of the patients with 90 Gy and 30% IDL at the brainstem, 59 (79.0%) had significant relief and 48.9% had numbness. Among 59 consecutive patients with similar dose but the 50% isodoseline at the brainstem, 49 patients (88.0%) had excellent/good relief. Numbness, averaging 2.49 on a subjective scale of 1 to 5, was experienced by 49.7% of the patients,
  
  
  CONCLUSIONS
  Increased radiation dose and volume of brainstem irradiation may improve clinical outcomes with the trade-off of trigeminal dysfunction. Further study of the implications of dose and target are needed to optimize outcomes and to minimize complications.
authors.affiliation: Department of Neurosurgery, UCLA Medical Center, West Los Angeles Veteran's Administration Hospital, Los Angeles, CA, USA.
authors.forename: Zachary A
authors.initials: ZA
authors.lastname: Smith
authors.forename: Alessandra A
authors.initials: AA
authors.lastname: Gorgulho
authors.forename: Nikita
authors.initials: N
authors.lastname: Bezrukiy
authors.forename: David
authors.initials: D
authors.lastname: McArthur
authors.forename: Nzhde
authors.initials: N
authors.lastname: Agazaryan
authors.forename: Michael T
authors.initials: MT
authors.lastname: Selch
authors.forename: Antonio A F
authors.initials: AA
authors.lastname: De Salles
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001933:Brain Stem / Q000528:radiation effects; D005260:Female; D006801:Humans; D006987:Hypesthesia / Q000209:etiology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011149:Pons / Q000528:radiation effects; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D012008:Recurrence; D012074:Remission Induction; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D014277:Trigeminal Neuralgia / Q000601:surgery*