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

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.

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

Linear Accelerator Radiosurgery Using 90 Gray for Essential Trigeminal Neuralgia: Results and Dose Volume Histogram Analysis

Neurosurgery ◽  
2003 ◽  
Vol 53 (4) ◽  
pp. 823-830 ◽  
Author(s):  
Bryan W. Goss ◽  
Leonardo Frighetto ◽  
Antonio A.F. DeSalles ◽  
Zachary Smith ◽  
Timothy Solberg ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Nerve Root ◽  
Linear Accelerator ◽  
Treatment Plan ◽  
Case Series ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Dose Volume ◽  
Facial Numbness

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.

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