title: Linear accelerator stereotactic radiosurgery for trigeminal neuralgia.
abstract: BACKGROUND
  Stereotactic radiosurgery is accepted as an alternative for patients with refractory trigeminal neuralgia, but existing evidence is fundamentally based on the Gamma Knife, which is a specific device for intracranial neurosurgery, available in few facilities. Over the last decade it has been shown that the use of linear accelerators can achieve similar diagnostic accuracy and equivalent dose distribution.
  
  
  OBJECTIVE
  To assess the effectiveness and safety of linear-accelerator stereotactic radiosurgery for the treatment of patients with refractory trigeminal neuralgia.
  
  
  METHODS
  We carried out a systematic search of the literature in the main electronic databases (PubMed, Embase, ISI Web of Knowledge, Cochrane, Biomed Central, IBECS, IME, CRD) and reviewed grey literature. All original studies on the subject published in Spanish, French, English, and Portuguese were eligible for inclusion. The selection and critical assessment was carried out by 2 independent reviewers based on pre-defined criteria. In view of the impossibility of carrying out a pooled analysis, data were analyzed in a qualitative way.
  
  
  RESULTS
  Eleven case series were included. In these, satisfactory pain relief (BIN I-IIIb or reduction in pain = 50) was achieved in 75% to 95.7% of the patients treated. The mean time to relief from pain ranged from 8.5 days to 3.8 months. The percentage of patients who presented with recurrences after one year of follow-up ranged from 5% to 28.8%. Facial swelling or hypoesthesia, mostly of a mild-moderate grade appeared in 7.5% - 51.9% of the patients. Complete anaesthesia dolorosa was registered in only study (5.3%). Cases of hearing loss (2.5%), brainstem edema (5.8%), and neurotrophic keratoplasty (3.5%) were also isolated.
  
  
  CONCLUSIONS
  The results suggest that stereotactic radiosurgery with linear accelerators could constitute an effective and safe therapeutic alternative for drug-resistant trigeminal neuralgia. However, existing studies leave important doubts as to optimal treatment doses or the therapeutic target, long-term recurrence, and do not help identify which subgroups of patients could most benefit from this technique.
  
  
  CONCLUSIONS
  Paucity of literature and clear lack of clarification for clinical utilization of this technique.
authors: Galician Agency for Health Technology Assessment, Galician Health Authority, Santiago de Compostela, Spain.
authors: Leonor
authors: L
authors: Varela-Lema
authors: Marisa
authors: M
authors: Lopez-Garcia
authors: Maria
authors: M
authors: Maceira-Rozas
authors: Victor
authors: V
authors: Munoz-Garzon
mesh_terms: D001929:Brain Edema; D001933:Brain Stem; D016208:Databases, Factual; D005500:Follow-Up Studies; D034381:Hearing Loss; D006801:Humans; D010315:Particle Accelerators; D011183:Postoperative Complications; D016634:Radiosurgery / Q000379:methods*; D012008:Recurrence; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000601:surgery*