Stereotactic Radiosurgery as Initial Surgical Management for Elderly Patients with Trigeminal Neuralgia

2017 ◽  
Vol 95 (3) ◽  
pp. 158-165 ◽  
Author(s):  
Jonathan Cohen ◽  
Seyed H. Mousavi ◽  
Amir H. Faraji ◽  
Berkcan Akpinar ◽  
Edward A. Monaco ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Elderly Patients ◽  
Stereotactic Radiosurgery ◽  
Surgical Management

Surgical Management of Trigeminal Neuralgia in Elderly Patients Using a Small Retrosigmoidal Approach: Analysis of Efficacy and Safety

2014 ◽  
Vol 76 (01) ◽  
pp. 39-45 ◽  
Author(s):  
Jaime Martínez-Anda ◽  
Juan Barges-Coll ◽  
Juan Ponce-Gomez ◽  
Nadia Perez-Pena ◽  
Rogelio Revuelta-Gutierrez
Keyword(s):  
Trigeminal Neuralgia ◽  
Elderly Patients ◽  
Surgical Management ◽  
Efficacy And Safety

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.

Surgical Management of Trigeminal Neuralgia Induced by Brainstem Infarct: A Systematic Review of the Literature

2021 ◽  
Author(s):  
Rachyl M. Shanker ◽  
Miri Kim ◽  
Chloe Verducci ◽  
Elhaum G. Rezaii ◽  
Kerry Steed ◽  
...  
Keyword(s):  
Systematic Review ◽  
Trigeminal Neuralgia ◽  
Surgical Management ◽  
Review Of The Literature

Microvascular decompression as a surgical management for trigeminal neuralgia: long-term follow-up and review of the literature

2008 ◽  
Vol 32 (1) ◽  
pp. 87-94 ◽  
Author(s):  
Serdar Kabatas ◽  
Aykut Karasu ◽  
Erdinc Civelek ◽  
Akin P. Sabanci ◽  
Kemal T. Hepgul ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Surgical Management ◽  
Microvascular Decompression ◽  
Review Of The Literature ◽  
Long Term Follow Up

Stereotactic Radiosurgery for Primary Trigeminal Neuralgia Using the Leksell Gamma Unit

2001 ◽  
Vol 76 (1) ◽  
pp. 29-35 ◽  
Author(s):  
Li-Gao Zheng ◽  
De-Sheng Xu ◽  
Chun-Sheng Kang ◽  
Zhi-Yuan Zhang ◽  
Yan-He Li ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Stereotactic Radiosurgery ◽  
Primary Trigeminal Neuralgia

scholarly journals Tumor control and trigeminal dysfunction improvement after stereotactic radiosurgery for trigeminal schwannomas: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Iulia Peciu-Florianu ◽  
Jean Régis ◽  
Marc Levivier ◽  
Michaela Dedeciusova ◽  
Nicolas Reyns ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Tumor Progression ◽  
Stereotactic Radiosurgery ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Symptomatic Improvement ◽  
Tumor Control ◽  
Linear Accelerators ◽  
Oculomotor Nerves ◽  
Clinical Worsening

AbstractTrigeminal nerve schwannomas (TS) are uncommon intracranial tumors, frequently presenting with debilitating trigeminal and/or oculomotor nerve dysfunction. While surgical resection has been described, its morbidity and mortality rates are non-negligible. Stereotactic radiosurgery (SRS) has emerged with variable results as a valuable alternative. Here, we aimed at reviewing the medical literature on TS treated with SRS so as to investigate rates of tumor control and symptomatic improvement. We reviewed manuscripts published between January 1990 and December 2019 on PubMed. Tumor control and symptomatic improvement rates were evaluated with separate meta-analyses. This meta-analysis included 18 studies comprising a total of 564 patients. Among them, only one reported the outcomes of linear accelerators (Linac), while the others of GK. Tumor control rates after SRS were 92.3% (range 90.1–94.5; p < 0.001), and tumor decrease rates were 62.7% (range 54.3–71, p < 0.001). Tumor progression rates were 9.4% (range 6.8–11.9, p < 0.001). Clinical improvement rates of trigeminal neuralgia were 63.5% (52.9–74.1, p < 0.001) and of oculomotor nerves were 48.2% (range 36–60.5, p < 0.001). Clinical worsening rate was 10.7% (range 7.6–13.8, p < 0.001). Stereotactic radiosurgery for TS is associated with high tumor control rates and favorable clinical outcomes, especially for trigeminal neuralgia and oculomotor nerves. However, patients should be correctly advised about the risk of tumor progression and potential clinical worsening. Future clinical studies should focus on standard reporting of clinical outcomes.

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