title: Refractory trigeminal neuralgia treatment outcomes following CyberKnife radiosurgery.
abstract: BACKGROUND
  A handful of studies have reported outcomes with CyberKnife radiosurgery (CKRS) for the treatment of trigeminal neuralgia. However, the follow-up has been short with no minimum follow-up required and have included patients with short duration of symptoms. Here we report our institutional experience on patients with a minimum follow-up of 1 year and a median follow-up of 28 months (mean 38.84 months).
  
  
  METHODS
  Twenty-five patients with medically and surgically intractable TN received CKRS with a mean marginal radiation dose of 64 Gy applied to an average isodose line of 86% of the affected trigeminal nerve. Follow-up data were obtained by clinical examination and telephone questionnaire. Outcome results were categorized based on the Barrow Neurological Institute (BNI) pain scale with BNI I-III considered to be good outcomes and BNI IV-V considered as treatment failure. BNI facial numbness score was used to assess treatment complications.
  
  
  RESULTS
  A large proportion of patients (42.9%) reported pain relief within 1 month following CKRS treatment. The mean time to recurrence of severe pain was 27.8 months (range 1-129 months). At median follow-up of 28 months (mean 38.84 months), actuarial rate of freedom from severe pain (BNI ≥ III) was 72%. At last follow-up 2 (8%) patients had freedom from any pain and no medications (BNI I) and the majority (48%) had some pain that was adequately controlled with medications. Seven patients (28%) had no response to treatment and continued to suffer from severe pain (BNI IV or V). Patient's diabetic status and overall post-treatment BNI facial numbness scores were statistically significant predictors of treatment outcomes.
  
  
  CONCLUSIONS
  CKRS represents an acceptable salvage option for with medically and/or surgically refractory patients. Even patients with severely debilitating symptoms may experience significant and sustained pain relief after CKRS. Particularly, CKRS remains an attractive option in patients who are not good surgical candidates or possibly even failed surgical therapy. This data should help in setting realistic expectations for weighing the various available treatment options.
authors.affiliation: Department of Radiation Oncology, University of Colorado Hospital, Aurora, CO, USA. sanadkaram@yahoo.com.
authors.forename: Sana D
authors.initials: SD
authors.lastname: Karam
authors.affiliation: Department of Radiation Oncology, Medstar Georgetown University Hospital, Washington, DC, USA. axt2@georgetown.edu.
authors.forename: Alexander
authors.initials: A
authors.lastname: Tai
authors.affiliation: Department of Radiation Oncology, University of Maryland, Baltimore, MD, USA. jsnider.umm@gmail.com.
authors.forename: James W
authors.initials: JW
authors.lastname: Snider
authors.affiliation: Department of Radiation Oncology, University of Colorado Hospital, Aurora, CO, USA. shilpa.bhatia@ucdenver.edu.
authors.forename: Shilpa
authors.initials: S
authors.lastname: Bhatia
authors.affiliation: Department of Biostatistics and Bioinformatics, University of Colorado, Aurora, CO, USA. edward.bedrick@ucdenver.edu.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Bedrick
authors.affiliation: Department of Radiation Oncology, Medstar Georgetown University Hospital, Washington, DC, USA. AXR11@gunet.georgetown.edu.
authors.forename: Abdul
authors.initials: A
authors.lastname: Rashid
authors.affiliation: Department of Radiation Oncology, Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC, 20007, USA. akj2@gunet.georgetown.edu.
authors.forename: Ann
authors.initials: A
authors.lastname: Jay
authors.affiliation: Department of Neurosurgery, Georgetown University Hospital, Washington, DC, USA. cgk6@georgetown.edu.
authors.forename: Christopher
authors.initials: C
authors.lastname: Kalhorn
authors.affiliation: Department of Neurosurgery, Georgetown University Hospital, Washington, DC, USA. nair.nathan@gmail.com.
authors.forename: Nathan
authors.initials: N
authors.lastname: Nair
authors.affiliation: Department of Radiation Oncology, Medstar Georgetown University Hospital, Washington, DC, USA. harterk@georgetown.edu.
authors.forename: K William
authors.initials: KW
authors.lastname: Harter
authors.affiliation: Department of Radiation Oncology, Medstar Georgetown University Hospital, Washington, DC, USA. spc9@georgetown.edu.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Collins
authors.affiliation: Department of Radiation Oncology, Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC, 20007, USA. WCJ4@gunet.georgetown.edu.|Department of Neurosurgery, Georgetown University Hospital, Washington, DC, USA. WCJ4@gunet.georgetown.edu.
authors.forename: Walter
authors.initials: W
authors.lastname: Jean
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000601:surgery*