Linear accelerator radiosurgery using 90 gray for essential trigeminal neuralgia: Results and dose volume histogram analysis

Bryan W. Goss, Leonardo Frighetto, Antonio A F DeSalles, Zachary Smith, Timothy Solberg, Michael Selch, Bruce E. Pollock, Jean Régis, Nicolas Massager, Marc Levivier, Kim J. Burchiel, Joseph C. Christiano, Douglas Kondziolka, William A. Friedman

Research output: Contribution to journalArticlepeer-review

61 Scopus citations

Abstract

OBJECTIVE: To evaluate treatment of essential trigeminal neuralgia with 90 Gy delivered by a linear accelerator dedicated to radiosurgery. METHODS: This is a retrospective case series of 25 patients with essential trigeminal neuralgia treated from March 1999 to March 2001. All were treated with 90 Gy by means of a 5-mm collimator directed to the nerve root entry zone. Patient follow-up (range, 8-52 mo; median, 18 mo) was completed by an uninvolved party. Dose volume histograms of the brainstem were developed for the 20, 30, and 50% isodose lines by means of radiosurgery planning software. RESULTS: All patients obtained good to excellent pain relief with treatment. Nineteen (76%) of 25 patients achieved excellent pain relief (pain-free without medication). Six patients (24%) achieved good pain relief (50-90% reduction of pain with or without medication). Median time to pain relief was 2 months. Eight patients (32%) experienced relapse 4 to 13 months after treatment. Eight patients (32%) developed facial numbness, but none developed painful numbness. Mean brainstem volume within the 50% isodose line and occurrence of numbness was statistically significant (P = 0.03). There was no correlation between brainstem volume treated and outcome. CONCLUSION: Dedicated linear accelerator-based stereotactic radiosurgery that uses a 5-mm collimator to deliver 90 Gy to the nerve root entry zone is a safe and effective method for the treatment of essential trigeminal neuralgia. Care should be taken to limit brainstem volume included in the 50% isodose line in the treatment plan to avoid facial numbness.

Original languageEnglish (US)
Pages (from-to)823-830
Number of pages8
JournalNeurosurgery
Volume53
Issue number4
DOIs
StatePublished - Oct 1 2003

Keywords

  • Facial pain
  • Linear accelerator
  • Stereotactic radiosurgery
  • Trigeminal neuralgia

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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