Dedicated linear accelerator radiosurgery for the treatment of trigeminal neuralgia

Zachary A. Smith, Antonio A F De Salles, Leonardo Frighetto, Bryan Goss, Steve P. Lee, Michael Selch, Robert E. Wallace, Cynthia Cabatan-Awang, Timothy Solberg

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Object. In this study the authors evaluate the efficacy of and complications associated with dedicated linear accelerator (LINAC) radiosurgery for trigeminal neuralgia (TN). Methods. Between August 1995 and February 2001, 60 patients whose median age was 66.1 years (range 45-88 years) were treated with dedicated LINAC radiosurgery for TN. Forty-one patients (68.3%) had essential TN, 12 (20%) had secondary facial pain, and seven (11.7%) had atypical features. Twenty-nine patients (48.3%) had undergone previous surgical procedures. Radiation doses varied between 70 and 90 Gy (mean 83.3 Gy) at the isocenter, with the last 35 patients (58.3%) treated with a 90-Gy dose. A 5-mm collimator was used in 45 patients (75%) and a 7.5-mm collimator in 15 patients (25%). Treatment was focused at the nerve root entry zone. At last follow up (mean follow-up period 23 months, range 2-70 months), 36 (87.8%) of the 41 patients with essential TN had sustained significant pain relief (good plus excellent results). Twenty-three patients (56.1%) were pain free without medication (excellent outcome), 13 (31.7%) had a 50 to 90% reduction in pain with or without medication (good outcome), and five (12.2%) had minor improvement or no relief. Of 12 patients with secondary facial pain, significant relief was sustained in seven patients (58.3%); worse results were found with atypical pain. Fifteen (25%) of the 60 patients experienced new numbness postprocedure; no other significant complications were found. Pain relief was experienced at a mean of 2.7 months (range 0-12 months). Conclusions. Dedicated LINAC radiosurgery is a precise and effective treatment for TN.

Original languageEnglish (US)
Pages (from-to)511-516
Number of pages6
JournalJournal of Neurosurgery
Volume99
Issue number3
StatePublished - Sep 1 2003

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Trigeminal Neuralgia
Radiosurgery
Therapeutics
Pain
Facial Pain
Hypesthesia
Radiation

Keywords

  • Linear accelerator
  • Stereotactic radiosurgery
  • Trigeminal neuralgia

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Smith, Z. A., De Salles, A. A. F., Frighetto, L., Goss, B., Lee, S. P., Selch, M., ... Solberg, T. (2003). Dedicated linear accelerator radiosurgery for the treatment of trigeminal neuralgia. Journal of Neurosurgery, 99(3), 511-516.

Dedicated linear accelerator radiosurgery for the treatment of trigeminal neuralgia. / Smith, Zachary A.; De Salles, Antonio A F; Frighetto, Leonardo; Goss, Bryan; Lee, Steve P.; Selch, Michael; Wallace, Robert E.; Cabatan-Awang, Cynthia; Solberg, Timothy.

In: Journal of Neurosurgery, Vol. 99, No. 3, 01.09.2003, p. 511-516.

Research output: Contribution to journalArticle

Smith, ZA, De Salles, AAF, Frighetto, L, Goss, B, Lee, SP, Selch, M, Wallace, RE, Cabatan-Awang, C & Solberg, T 2003, 'Dedicated linear accelerator radiosurgery for the treatment of trigeminal neuralgia', Journal of Neurosurgery, vol. 99, no. 3, pp. 511-516.
Smith ZA, De Salles AAF, Frighetto L, Goss B, Lee SP, Selch M et al. Dedicated linear accelerator radiosurgery for the treatment of trigeminal neuralgia. Journal of Neurosurgery. 2003 Sep 1;99(3):511-516.
Smith, Zachary A. ; De Salles, Antonio A F ; Frighetto, Leonardo ; Goss, Bryan ; Lee, Steve P. ; Selch, Michael ; Wallace, Robert E. ; Cabatan-Awang, Cynthia ; Solberg, Timothy. / Dedicated linear accelerator radiosurgery for the treatment of trigeminal neuralgia. In: Journal of Neurosurgery. 2003 ; Vol. 99, No. 3. pp. 511-516.
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abstract = "Object. In this study the authors evaluate the efficacy of and complications associated with dedicated linear accelerator (LINAC) radiosurgery for trigeminal neuralgia (TN). Methods. Between August 1995 and February 2001, 60 patients whose median age was 66.1 years (range 45-88 years) were treated with dedicated LINAC radiosurgery for TN. Forty-one patients (68.3{\%}) had essential TN, 12 (20{\%}) had secondary facial pain, and seven (11.7{\%}) had atypical features. Twenty-nine patients (48.3{\%}) had undergone previous surgical procedures. Radiation doses varied between 70 and 90 Gy (mean 83.3 Gy) at the isocenter, with the last 35 patients (58.3{\%}) treated with a 90-Gy dose. A 5-mm collimator was used in 45 patients (75{\%}) and a 7.5-mm collimator in 15 patients (25{\%}). Treatment was focused at the nerve root entry zone. At last follow up (mean follow-up period 23 months, range 2-70 months), 36 (87.8{\%}) of the 41 patients with essential TN had sustained significant pain relief (good plus excellent results). Twenty-three patients (56.1{\%}) were pain free without medication (excellent outcome), 13 (31.7{\%}) had a 50 to 90{\%} reduction in pain with or without medication (good outcome), and five (12.2{\%}) had minor improvement or no relief. Of 12 patients with secondary facial pain, significant relief was sustained in seven patients (58.3{\%}); worse results were found with atypical pain. Fifteen (25{\%}) of the 60 patients experienced new numbness postprocedure; no other significant complications were found. Pain relief was experienced at a mean of 2.7 months (range 0-12 months). Conclusions. Dedicated LINAC radiosurgery is a precise and effective treatment for TN.",
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