Outcome for Patients with Essential Trigeminal Neuralgia Treated with Linear Accelerator Stereotactic Radiosurgery

2011 ◽  
Vol 89 (4) ◽  
pp. 220-225 ◽  
Author(s):  
Marcos Antonio dos Santos ◽  
José Bustos Pérez de Salcedo ◽  
José Angel Gutiérrez Diaz ◽  
Gorka Nagore ◽  
Felipe A. Calvo ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Stereotactic Radiosurgery ◽  
Linear Accelerator

scholarly journals Linear Accelerator Stereotactic Radiosurgery for Trigeminal Neuralgia

2015 ◽  
Vol 18;1 (1;1) ◽  
pp. 15-27
Author(s):  
Leonor Varela-Lema
Keyword(s):  
Trigeminal Neuralgia ◽  
Stereotactic Radiosurgery ◽  
Linear Accelerator ◽  
Grey Literature ◽  
Case Series ◽  
Analysis Data ◽  
Pooled Analysis ◽  
Linear Accelerators ◽  
Clinical Utilization ◽  
Facial Swelling

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. Objectives: 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. Limitations: Paucity of literature and clear lack of clarification for clinical utilization of this technique. Key words: Radiosurgery, trigeminal neuralgia, functional radiosurgery, radiation therapy of benign diseases, stereotactic radiotherapy

Functional stereotactic radiosurgery involving a dedicated linear accelerator and gamma unit: a comparison study

2004 ◽  
pp. 373-380 ◽  
Author(s):  
Timothy D. Solberg ◽  
Steven J. Goetsch ◽  
Michael T. Selch ◽  
William Melega ◽  
Goran Lacan ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Linear Accelerator ◽  
Treatment Plan ◽  
Single Shot ◽  
Submillimeter Range ◽  
Primate Model ◽  
Content Type ◽  
Stereotactic Frame ◽  
Targeting Ability ◽  
Fine Print

Object. The purpose of this work was to investigate the targeting and dosimetric characteristics of a linear accelerator (LINAC) system dedicated for stereotactic radiosurgery compared with those of a commercial gamma knife (GK) unit. Methods. A phantom was rigidly affixed within a Leksell stereotactic frame and axial computerized tomography scans were obtained using an appropriate stereotactic localization device. Treatment plans were performed, film was inserted into a recessed area, and the phantom was positioned and treated according to each treatment plan. In the case of the LINAC system, four 140° arcs, spanning ± 60° of couch rotation, were used. In the case of the GK unit, all 201 sources were left unplugged. Radiation was delivered using 3- and 8-mm LINAC collimators and 4- and 8-mm collimators of the GK unit. Targeting ability was investigated independently on the dedicated LINAC by using a primate model. Measured 50% spot widths for multisource, single-shot radiation exceeded nominal values in all cases by 38 to 70% for the GK unit and 11 to 33% for the LINAC system. Measured offsets were indicative of submillimeter targeting precision on both devices. In primate studies, the appearance of an magnetic resonance imaging—enhancing lesion coincided with the intended target. Conclusions. Radiosurgery performed using the 3-mm collimator of the dedicated LINAC exhibited characteristics that compared favorably with those of a dedicated GK unit. Overall targeting accuracy in the submillimeter range can be achieved, and dose distributions with sharp falloff can be expected for both devices.

Geometrical accuracy of the Novalis stereotactic radiosurgery system for trigeminal neuralgia

2004 ◽  
Vol 101 (Supplement3) ◽  
pp. 351-355 ◽  
Author(s):  
Javad Rahimian ◽  
Joseph C. Chen ◽  
Ajay A. Rao ◽  
Michael R. Girvigian ◽  
Michael J. Miller ◽  
...  
Keyword(s):  
Quality Assurance ◽  
Trigeminal Neuralgia ◽  
Image Fusion ◽  
Stereotactic Radiosurgery ◽  
Ct Images ◽  
Radiochromic Film ◽  
Quality Assurance Program ◽  
Content Type ◽  
Geometrical Accuracy ◽  
Fine Print

Object. Stringent geometrical accuracy and precision are required in the stereotactic radiosurgical treatment of patients. Accurate targeting is especially important when treating a patient in a single fraction of a very high radiation dose (90 Gy) to a small target such as that used in the treatment of trigeminal neuralgia (3 to 4—mm diameter). The purpose of this study was to determine the inaccuracies in each step of the procedure including imaging, fusion, treatment planning, and finally the treatment. The authors implemented a detailed quality-assurance program. Methods. Overall geometrical accuracy of the Novalis stereotactic system was evaluated using a Radionics Geometric Phantom Chamber. The phantom has several magnetic resonance (MR) and computerized tomography (CT) imaging—friendly objects of various shapes and sizes. Axial 1-mm-thick MR and CT images of the phantom were acquired using a T1-weighted three-dimensional spoiled gradient recalled pulse sequence and the CT scanning protocols used clinically in patients. The absolute errors due to MR image distortion, CT scan resolution, and the image fusion inaccuracies were measured knowing the exact physical dimensions of the objects in the phantom. The isocentric accuracy of the Novalis gantry and the patient support system was measured using the Winston—Lutz test. Because inaccuracies are cumulative, to calculate the system's overall spatial accuracy, the root mean square (RMS) of all the errors was calculated. To validate the accuracy of the technique, a 1.5-mm-diameter spherical marker taped on top of a radiochromic film was fixed parallel to the x–z plane of the stereotactic coordinate system inside the phantom. The marker was defined as a target on the CT images, and seven noncoplanar circular arcs were used to treat the target on the film. The calculated system RMS value was then correlated with the position of the target and the highest density on the radiochromic film. The mean spatial errors due to image fusion and MR imaging were 0.41 ± 0.3 and 0.22 ± 0.1 mm, respectively. Gantry and couch isocentricities were 0.3 ± 0.1 and 0.6 ± 0.15 mm, respectively. The system overall RMS values were 0.9 and 0.6 mm with and without the couch errors included, respectively (isocenter variations due to couch rotation are microadjusted between couch positions). The positional verification of the marker was within 0.7 ± 0.1 mm of the highest optical density on the radiochromic film, correlating well with the system's overall RMS value. The overall mean system deviation was 0.32 ± 0.42 mm. Conclusions. The highest spatial errors were caused by image fusion and gantry rotation. A comprehensive quality-assurance program was developed for the authors' stereotactic radiosurgery program that includes medical imaging, linear accelerator mechanical isocentricity, and treatment delivery. For a successful treatment of trigeminal neuralgia with a 4-mm cone, the overall RMS value of equal to or less than 1 mm must be guaranteed.

Management of choroidal melanomas with linear accelerator-based stereotactic radiosurgery

1999 ◽  
Vol 77 (1) ◽  
pp. 62-65 ◽  
Author(s):  
Stephen Wan Leung ◽  
Ching-Yeh Hsiung ◽  
Hui-Chun Chen ◽  
Han-Jung Chen ◽  
Sue-Ann Lin
Keyword(s):  
Stereotactic Radiosurgery ◽  
Linear Accelerator ◽  
Choroidal Melanomas
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