title: Pain experience using conventional versus angled anterior posts during stereotactic head frame placement for radiosurgery.
abstract: Stereotactic frame placement for radiosurgery is assumed to be an uncomfortable experience. We developed angled anterior posts for the Leksell frame to avoid pin penetration of the temporalis muscle. This study aimed to determine the frequency of angled post requirement and quantify the patient pain experience from frame placement. We prospectively enrolled 63 patients undergoing radiosurgery. Angled posts were used when conventional post trajectory was posterior or within 3mm of the superior temporal line to avoid temporalis muscle penetration. Pain scores (0 to 10) were collected prior to frame placement, immediately after frame placement, before radiosurgery, after radiosurgery, and a day after radiosurgery. A total of 63 patients were enrolled: 33 (48%) patients required angled posts. Women were significantly more likely to require angled posts than men (60.0% versus 33.3%, respectively; p=0.034). Mean pain scores were very low, ranging from 0.33 to 2.23. There were no significant differences in pain outcomes between both groups at all time points. Stereotactic frame placement is not perceived to be a painful procedure. This information may be useful when counseling patients about the pain experience with frame application and the option of using angled anterior posts.
authors.affiliation: Department of Neurosurgery, University of California San Francisco, 505 Parnassus Avenue, M 779, San Francisco, CA 94143-0112, USA.
authors.forename: Doris D
authors.initials: DD
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, University of California San Francisco, 505 Parnassus Avenue, M 779, San Francisco, CA 94143-0112, USA.
authors.forename: Darryl
authors.initials: D
authors.lastname: Lau
authors.affiliation: Department of Neurosurgery, University of California San Francisco, 505 Parnassus Avenue, M 779, San Francisco, CA 94143-0112, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Rolston
authors.affiliation: Department of Neurosurgery, University of California San Francisco, 505 Parnassus Avenue, M 779, San Francisco, CA 94143-0112, USA.
authors.forename: Dario J
authors.initials: DJ
authors.lastname: Englot
authors.affiliation: Department of Radiation Oncology, University of California San Francisco, CA, USA.
authors.forename: Patricia K
authors.initials: PK
authors.lastname: Sneed
authors.affiliation: Department of Neurosurgery, University of California San Francisco, 505 Parnassus Avenue, M 779, San Francisco, CA 94143-0112, USA. Electronic address: McDermottM@neurosurg.ucsf.edu.
authors.forename: Michael W
authors.initials: MW
authors.lastname: McDermott
mesh_terms: D001932:Brain Neoplasms / Q000601:surgery; D004867:Equipment Design; D005260:Female; D006257:Head; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology*; D010147:Pain Measurement; D011446:Prospective Studies; D016634:Radiosurgery / Q000295:instrumentation* / Q000379:methods; D012727:Sex Characteristics; D013238:Stereotaxic Techniques / Q000295:instrumentation*
keywords: Frame application; Leksell frame; Pain experience; Radiosurgery; Stereotactic frame