1
|
Liu M, Cygler JE, Tiberi D, Doody J, Malone S, Vandervoort E. Dosimetric impact of rotational errors in trigeminal neuralgia radiosurgery using CyberKnife. J Appl Clin Med Phys 2024; 25:e14238. [PMID: 38131465 PMCID: PMC11005971 DOI: 10.1002/acm2.14238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE Trigeminal neuralgia (TN) can be treated on the CyberKnife system using two different treatment delivery paths: the general-purpose full path corrects small rotations, while the dedicated trigeminal path improves dose fall-off but does not allow rotational corrections. The study evaluates the impact of uncorrected rotations on brainstem dose and the length of CN5 (denoted as Leff) covered by the prescription dose. METHODS AND MATERIALS A proposed model estimates the delivered dose considering translational and rotational delivery errors for TN treatments on the CyberKnife system. The model is validated using radiochromic film measurements with and without rotational setup error for both paths. Leff and the brainstem dose is retrospectively assessed for 24 cases planned using the trigeminal path. For 15 cases, plans generated using both paths are compared for the target coverage and toxicity to the brainstem. RESULTS In experimental validations, measured and estimated doses agree at 1%/1 mm level. For 24 cases, the treated Leff is 5.3 ± 1.7 mm, reduced from 5.9 ± 1.8 mm in the planned dose. Constraints for the brainstem are met in 23 cases for the treated dose but require frequent treatment interruption to maintain rotational corrections <0.5° using the trigeminal path. The treated length of CN5, and plan quality metrics are similar for the two paths, favoring the full path where rotations are corrected. CONCLUSIONS We validated an analytical model that can provide patient-specific tolerances on rotations to meet plan objectives. Treatment using the full path can reduce treatment time and allow for rotational corrections.
Collapse
Affiliation(s)
- Ming Liu
- Department of Medical PhysicsThe Ottawa Hospital Cancer CenterOttawaOntarioCanada
- Department of PhysicsCarleton UniversityOttawaOntarioCanada
| | - Joanna E Cygler
- Department of Medical PhysicsThe Ottawa Hospital Cancer CenterOttawaOntarioCanada
- Department of PhysicsCarleton UniversityOttawaOntarioCanada
- Department of RadiologyUniversity of OttawaOttawaOntarioCanada
| | - David Tiberi
- Department of Radiation OncologyThe Ottawa Hospital Cancer CentreOttawaOntarioCanada
- Department of Radiation OncologyUniversity of OttawaOttawaOntarioCanada
| | - Janice Doody
- Radiation Medicine ProgramThe Ottawa Hospital Cancer CentreOttawaOntarioCanada
| | - Shawn Malone
- Department of Radiation OncologyThe Ottawa Hospital Cancer CentreOttawaOntarioCanada
- Department of Radiation OncologyUniversity of OttawaOttawaOntarioCanada
| | - Eric Vandervoort
- Department of Medical PhysicsThe Ottawa Hospital Cancer CenterOttawaOntarioCanada
- Department of PhysicsCarleton UniversityOttawaOntarioCanada
- Department of RadiologyUniversity of OttawaOttawaOntarioCanada
| |
Collapse
|
2
|
De La Peña NM, Singh R, Anderson ML, Koester SW, Sio TT, Ashman JB, Vora SA, Patel NP. High-Dose Frameless Stereotactic Radiosurgery for Trigeminal Neuralgia: A Single-Institution Experience and Systematic Review. World Neurosurg 2022; 167:e432-e443. [PMID: 35973520 DOI: 10.1016/j.wneu.2022.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 08/08/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Stereotactic radiosurgery is an effective treatment option for trigeminal neuralgia (TN), with frameless stereotactic radiosurgery (fSRS) allowing for a less invasive experience. A single-institutional series and systematic review of the literature were performed for cases of TN treated with fSRS. METHODS Patients at our institution with TN that were treated with fSRS from the years 2012-2021 were included. Similarly, multiple databases were searched for studies regarding TN treated with fSRS where patient-level data was included from 2004-2020. Pain levels, via the Barrow Neurological Institute (BNI) scale, before and after treatment were analyzed. Pooled analysis was performed to compare treatment outcomes between studies using CyberKnife and LINAC modalities. RESULTS Twenty-three patients at our institution were treated with LINAC fSRS (median treatment dose: 85 Gy). Most patients had TN refractory to previous procedural treatments. Eight (35%) patients had an excellent posttreatment response (BNI I-II), while 11 (48%) patients had a good result (BNI IIIa/b). Eight patients had recurrence of pain. A total of 30 articles were included in the systematic review, encompassing 1705 patients. At last follow-up, 63.1% (774/1227) of patients endorsed an excellent response, while 16.1% (197/1227) had a good response, and 22.5% (215/957) of patients had recurrence. Pain response, facial numbness rates, and pain recurrence rates were not significantly different between CyberKnife and LINAC modalities. CONCLUSIONS Frameless SRS for TN appears to be an efficacious noninvasive option for patients with substantial comorbidities, who have failed other treatment methods, although it can be limited by higher recurrence rates.
Collapse
Affiliation(s)
| | - Rohin Singh
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, USA
| | | | - Stefan W Koester
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Terence T Sio
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Jonathan B Ashman
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Sujay A Vora
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Naresh P Patel
- Department of Neurological Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA
| |
Collapse
|
3
|
Bal J, Bruneau M, Berhouma M, Cornelius JF, Cavallo LM, Daniel RT, Froelich S, Jouanneau E, Meling TR, Messerer M, Roche PH, Schroeder HWS, Tatagiba M, Zazpe I, Paraskevopoulos D. Management of non-vestibular schwannomas in adult patients: a systematic review and consensus statement on behalf of the EANS skull base section Part II: Trigeminal and facial nerve schwannomas (CN V, VII). Acta Neurochir (Wien) 2022; 164:299-319. [PMID: 35079891 DOI: 10.1007/s00701-021-05092-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/17/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Non-vestibular schwannomas are relatively rare, with trigeminal and jugular foramen schwannomas being the most common. This is a heterogenous group which requires detailed investigation and careful consideration to management strategy. The optimal management for these tumours remains unclear and there are several controversies. The aim of this paper is to provide insight into the main principles defining management and surgical strategy, in order to formulate a series of recommendations. METHODS A task force was created by the EANS skull base section committee along with its members and other renowned experts in the field to generate recommendations for the surgical management of these tumours on a European perspective. To achieve this, the task force performed an extensive systematic review in this field and had discussions within the group. This article is the second of a three-part series describing non-vestibular schwannomas (V, VII). RESULTS A summary of literature evidence was proposed after discussion within the EANS skull base section. The constituted task force dealt with the practice patterns that exist with respect to pre-operative radiological investigations, ophthalmological assessments, optimal surgical and radiotherapy strategies, and follow-up management. CONCLUSION This article represents the consensually derived opinion of the task force with respect to the treatment of trigeminal and facial schwannoma. The aim of treatment is maximal safe resection with preservation of function. Careful thought is required to select the appropriate surgical approach. Most middle fossa trigeminal schwannoma tumours can be safely accessed by a subtemporal extradural middle fossa approach. The treatment of facial nerve schwannoma remains controversial.
Collapse
Affiliation(s)
- Jarnail Bal
- Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and The Royal London Hospital, London, UK
| | - Michael Bruneau
- Department of Neurosurgery, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Moncef Berhouma
- Neuro-Oncologic and Vascular Department, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - Jan F Cornelius
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Luigi M Cavallo
- Department of Neurosurgery, University Hospital of Naples Federico II, Napoli, Italy
| | - Roy T Daniel
- Department of Neurosurgery, Lausanne University Hospital and University of Lausanne, 42 rue du Bugnon, 1011, Lausanne, Switzerland
| | | | - Emmanuel Jouanneau
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - Torstein R Meling
- Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland
| | - Mahmoud Messerer
- Department of Neurosurgery, Lausanne University Hospital and University of Lausanne, 42 rue du Bugnon, 1011, Lausanne, Switzerland
| | | | - Henry W S Schroeder
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Idoya Zazpe
- Department of Neurosurgery, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Dimitrios Paraskevopoulos
- Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and The Royal London Hospital, London, UK.
| |
Collapse
|
4
|
Abstract
When radiation is focally delivered to brain tissue at sub-ablative doses, neural activity may be altered. When done at a specific brain circuit node or connection, this is referred to as “radiomodulation.” Radiation-induced effects on brain tissue, basic science, and clinical research that supports the radiomodulation hypothesis are reviewed in this article. We review progress in defining the necessary parameters in terms of dose, volumes, and anatomical location. It may be possible to deliver therapeutic neuromodulation that is non-invasive, non-destructive, and durable.
Collapse
Affiliation(s)
- M Bret Schneider
- Chief Medical Officer, Zap Surgical Systems, Inc., San Carlos, USA.,Department of Psychiatry, Stanford University School of Medicine, Stanford, USA
| | - Brian Walcott
- Neurosurgery, University of Chicago, Chicago, USA.,Neurosurgery, Northshore University HealthSystem, Evanston, USA
| | - John R Adler
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, USA
| |
Collapse
|
5
|
Fatima N, Meola A, Ding VY, Pollom E, Soltys SG, Chuang CF, Shahsavari N, Hancock SL, Gibbs IC, Adler JR, Chang SD. The Stanford stereotactic radiosurgery experience on 7000 patients over 2 decades (1999-2018): looking far beyond the scalpel. J Neurosurg 2021; 135:1725-1741. [PMID: 33799297 DOI: 10.3171/2020.9.jns201484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 09/11/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The CyberKnife (CK) has emerged as an effective frameless and noninvasive method for treating a myriad of neurosurgical conditions. Here, the authors conducted an extensive retrospective analysis and review of the literature to elucidate the trend for CK use in the management paradigm for common neurosurgical diseases at their institution. METHODS A literature review (January 1990-June 2019) and clinical review (January 1999-December 2018) were performed using, respectively, online research databases and the Stanford Research Repository of patients with intracranial and spinal lesions treated with CK at Stanford. For each disease considered, the coefficient of determination (r2) was estimated as a measure of CK utilization over time. A change in treatment modality was assessed using a t-test, with statistical significance assessed at the 0.05 alpha level. RESULTS In over 7000 patients treated with CK for various brain and spinal lesions over the past 20 years, a positive linear trend (r2 = 0.80) in the system's use was observed. CK gained prominence in the management of intracranial and spinal arteriovenous malformations (AVMs; r2 = 0.89 and 0.95, respectively); brain and spine metastases (r2 = 0.97 and 0.79, respectively); benign tumors such as meningioma (r2 = 0.85), vestibular schwannoma (r2 = 0.76), and glomus jugulare tumor (r2 = 0.89); glioblastoma (r2 = 0.54); and trigeminal neuralgia (r2 = 0.81). A statistically significant difference in the change in treatment modality to CK was observed in the management of intracranial and spinal AVMs (p < 0.05), and while the treatment of brain and spine metastases, meningioma, and glioblastoma trended toward the use of CK, the change in treatment modality for these lesions was not statistically significant. CONCLUSIONS Evidence suggests the robust use of CK for treating a wide range of neurological conditions.
Collapse
Affiliation(s)
| | | | | | - Erqi Pollom
- 2Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Scott G Soltys
- 2Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Cynthia F Chuang
- 2Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | | | - Steven L Hancock
- 2Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Iris C Gibbs
- 2Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | | | | |
Collapse
|
6
|
Conti A, Acker G, Pontoriero A, Hardt J, Kluge A, Cacciola A, Iatì G, Kufeld M, Budach V, Vajkoczy P, Beltramo G, Pergolizzi S, Bergantin A, Loebel F, Parisi S, Senger C, Romanelli P. Factors affecting outcome in frameless non-isocentric stereotactic radiosurgery for trigeminal neuralgia: a multicentric cohort study. Radiat Oncol 2020; 15:115. [PMID: 32443978 PMCID: PMC7243318 DOI: 10.1186/s13014-020-01535-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) is an effective treatment for trigeminal neuralgia (TN). Nevertheless, a proportion of patients will experience recurrence and treatment-related sensory disturbances. In order to evaluate the predictors of efficacy and safety of image-guided non-isocentric radiosurgery, we analyzed the impact of trigeminal nerve volume and the nerve dose/volume relationship, together with relevant clinical characteristics. METHODS Two-hundred and ninety-six procedures were performed on 262 patients at three centers. In 17 patients the TN was secondary to multiple sclerosis (MS). Trigeminal pain and sensory disturbances were classified according to the Barrow Neurological Institute (BNI) scale. Pain-free-intervals were investigated using Kaplan Meier analyses. Univariate and multivariate Cox regression analyses were performed to identify predictors. RESULTS The median follow-up period was 38 months, median maximal dose 72.4 Gy, median target nerve volume 25 mm3, and median prescription dose 60 Gy. Pain control rate (BNI I-III) at 6, 12, 24, 36, 48, and 60 months were 96.8, 90.9, 84.2, 81.4, 74.2, and 71.2%, respectively. Overall, 18% of patients developed sensory disturbances. Patients with volume ≥ 30 mm3 were more likely to maintain pain relief (p = 0.031), and low integral dose (< 1.4 mJ) tended to be associated with more pain recurrence than intermediate (1.4-2.7 mJ) or high integral dose (> 2.7 mJ; low vs. intermediate: log-rank test, χ2 = 5.02, p = 0.019; low vs. high: log-rank test, χ2 = 6.026, p = 0.014). MS, integral dose, and mean dose were the factors associated with pain recurrence, while re-irradiation and MS were predictors for sensory disturbance in the multivariate analysis. CONCLUSIONS The dose to nerve volume ratio is predictive of pain recurrence in TN, and re-irradiation has a major impact on the development of sensory disturbances after non-isocentric SRS. Interestingly, the integral dose may differ significantly in treatments using apparently similar dose and volume constraints.
Collapse
Affiliation(s)
- Alfredo Conti
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany. .,Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany. .,Unit of Neurosurgery, IRCCS ISNB Istituto delle Scienze Neurologiche di Bologna; Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
| | - Gueliz Acker
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, Berlin, 10178, Germany
| | | | - Juliane Hardt
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin AND Berlin Institute of Health , Berlin, Germany.,Clinical Research Unit (CRU), Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,Fakultät III, Dep. Information & Communication, Medical Information Management, Hochschule Hannover - University of Applied Sciences and Arts, Expo Plaza 12, 30539, Hannover, Germany
| | - Anne Kluge
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.,Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Alberto Cacciola
- Department of Radiation Oncology, University of Messina, Messina, Italy
| | - Giuseppe Iatì
- Department of Radiation Oncology, University of Messina, Messina, Italy
| | - Markus Kufeld
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Volker Budach
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.,Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | | | | | | | - Franziska Loebel
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Silvana Parisi
- Department of Radiation Oncology, University of Messina, Messina, Italy
| | - Carolin Senger
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.,Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | | |
Collapse
|
7
|
Straube C, Shiban E, Meyer B, Combs SE. [Radiosurgery and surgical neurovascular decompression are almost equal for treatment of trigeminal neuralgia]. Strahlenther Onkol 2019; 195:688-690. [PMID: 30949720 DOI: 10.1007/s00066-019-01454-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Christoph Straube
- Klinik für Strahlentherapie und RadioOnkologie des Klinikums rechts der Isar, Technische Universität München (TUM), Ismaninger Straße 22, 81675, München, Deutschland
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Deutschland
- Partner Site Munich, Deutsches Konsortium für Translationale Krebsforschung (DKTK), München, Deutschland
| | - Ehab Shiban
- Klinik für Neurochirurgie des Klinikums rechts der Isar, Technische Universität München (TUM), Ismaninger Straße 22, München, Deutschland
| | - Bernhard Meyer
- Klinik für Neurochirurgie des Klinikums rechts der Isar, Technische Universität München (TUM), Ismaninger Straße 22, München, Deutschland
| | - Stephanie E Combs
- Klinik für Strahlentherapie und RadioOnkologie des Klinikums rechts der Isar, Technische Universität München (TUM), Ismaninger Straße 22, 81675, München, Deutschland.
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Deutschland.
- Partner Site Munich, Deutsches Konsortium für Translationale Krebsforschung (DKTK), München, Deutschland.
| |
Collapse
|
8
|
Romanelli P, Conti A, Redaelli I, Martinotti AS, Bergantin A, Bianchi LC, Beltramo G. Cyberknife Radiosurgery for Trigeminal Neuralgia. Cureus 2019; 11:e6014. [PMID: 31815078 PMCID: PMC6881081 DOI: 10.7759/cureus.6014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Introduction Image-guided robotic radiosurgery is an emerging minimally-invasive treatment option for trigeminal neuralgia (TN). Our group has treated 560 cases up to date, and report here the clinical outcomes of 387 treatments with three years follow-up. This study represents the largest single-center experience on CyberKnife radiosurgery for the treatment of TN so far reported. Methods CyberKnife radiosurgery treatment was offered to patients with drug-resistant TN, after the failure of other treatments or refusal of invasive procedures. A second treatment was offered to patients with a poor response after the first treatment or with recurrent pain. Treatment protocol required the non-isocentric delivery of 60 Gy prescribed to the 80% isodose to a 6 mm retrogasserian segment of the affected trigeminal nerve. Retreatments typically received 45 Gy, again prescribed to the 80% isodose. The final plan was developed accordingly to individual anatomy and dose distribution over the trigeminal nerve, gasserian ganglion, and brainstem. Clinical outcomes such as pain control and hypoesthesia/numbness have been evaluated after 6, 12, 24, and 36 months. Results Our group has treated 527 patients with Cyberknife radiosurgery at Centro Diagnostico Italiano (CDI), Milan, Italy, during the last decade. A minimum follow-up of six months was available on 496 patients. These patients received 560 treatments: 435 patients (87.7%) had a single treatment, 60 patients (12.1%) had two treatments, and one patient (0.2%) had five treatments (two on the right side, three on the left side). Twenty four patients had multiple sclerosis (4.8%). Four hundred and forty-three patients (84%) received the treatment without previous procedures, while 84 patients (16%) underwent radiosurgery after the failure of other treatments. A neurovascular conflict was identified in 59% of the patients. Three hundred and forty-three patients (receiving a total of 387 treatments) had a minimum of 36 months follow up. Pain relief rate at 6, 12, 18, 24, 30 and 36 months was respectively 92, 87, 87, 82, 78 and 76%. Forty-four patients out of 343 (12.8%) required a second treatment during the observed period. At 36 months post-treatment, 21 patients (6,1%) reported the presence of bothering facial hypoesthesia. Eighteen patients out of 21 (85.7%) developed this complication after a repeated treatment. Conclusions Frameless image-guided robotic radiosurgery in experienced hands is a safe and effective procedure for the treatment of TN, providing excellent pain control rates in the absence of major neurological complications. Repeated treatments due to recurrent pain are associated with restored pain control but at the price of a higher rate of sensory complications.
Collapse
Affiliation(s)
- Pantaleo Romanelli
- Neurosurgery, Cyberknife Center, Centro Diagnostico Italiano, Milano, ITA
| | | | - Irene Redaelli
- Medical Physics, Cyberknife Center, Centro Diagnostico Italiano, Milano, ITA
| | | | - Achille Bergantin
- Medical Physics, Cyberknife Center, Centro Diagnostico Italiano, Milano, ITA
| | | | - Giancarlo Beltramo
- Radiation Oncology, Cyberknife Center, Centro Diagnostico Italiano, Milano, ITA
| |
Collapse
|
9
|
Berti A, Ibars G, Wu X, Sabo A, Granville M, Suarez G, Schwade JG, Jacobson RE. Evaluation of CyberKnife Radiosurgery for Recurrent Trigeminal Neuralgia. Cureus 2018; 10:e2598. [PMID: 30013862 PMCID: PMC6039152 DOI: 10.7759/cureus.2598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 05/09/2018] [Indexed: 11/07/2022] Open
Abstract
Stereotactic radiosurgery (SRS) has evolved as an accepted treatment for medication resistant trigeminal neuralgia. Initial results are very good but follow-up over three to five years shows a gradual return of pain in up to 50% of treated patients, often requiring further treatment. The results with repeat SRS using the isocentric Gamma Knife (GK) (Elekta, Stockholm, Sweden), especially in patients having initially good results, are very similar to the outcomes after the initial treatment although there is an increased risk of residual facial numbness secondary to the additional radiation dose to the trigeminal nerve. However, after 2000, non-isocentric SRS systems began to be used for treating trigeminal neuralgia including the CyberKnife (CK) (Accuray, Sunnyvale, California) as well as various linear accelerator (LINAC) based systems. This report specifically examines a series of recurrent trigeminal cases treated by the same group of physicians with the CK system. Similar doses and locations on the trigeminal nerve and/or the root entry zone were used for both initial and repeat SRS treatment regardless of system used. Although there are numerous series reporting the use of GK for recurrent treatment for recurrent trigeminal neuralgia, there are no series reviewing the results and long-term effectiveness using CK for repeat SRS for recurrent trigeminal pain. We reviewed 23 cases that had initial treatment for trigeminal neuralgia either surgically or with SRS with either the GK or CK and then a later second procedure only with CK. The follow-up after the second CK SRS ranged from three to 13 years found that the results are very similar to the multiple reports in the literature describing second or third SRS treatments with the GK. Results of repeat radiosurgery treatment of recurrent trigeminal neuralgia appear to be independent of the system used and are primarily based on proper target and dose to the trigeminal nerve.
Collapse
Affiliation(s)
- Aldo Berti
- Department Neurosurgery, University of Miami Hospital, Miami, USA
| | - George Ibars
- Neurosurgery, South Miami Hospital, Cyberknife Center of Miami
| | - Xiaodong Wu
- Innovative Cancer Institute, Innovative Cancer Institute, Cyberknife Center of Miami
| | - Alex Sabo
- Neurology, Pain Management, Nova Southeast/larkin Community Hospital
| | | | | | - James G Schwade
- Cyberknife Center of Miami, University of Miami Miller School of Medicine
| | - Robert E Jacobson
- Miami Neurosurgical Center, University of Miami Hospital, Miami, USA
| |
Collapse
|
10
|
Zhang M, Lamsam LA, Schoen MK, Mehta SS, Appelboom G, Adler JK, Soltys SG, Chang SD. Brainstem Dose Constraints in Nonisometric Radiosurgical Treatment Planning of Trigeminal Neuralgia: A Single-Institution Experience. World Neurosurg 2018; 113:e399-e407. [DOI: 10.1016/j.wneu.2018.02.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 02/05/2018] [Accepted: 02/06/2018] [Indexed: 11/30/2022]
|
11
|
Tuleasca C, Régis J, Sahgal A, De Salles A, Hayashi M, Ma L, Martínez-Álvarez R, Paddick I, Ryu S, Slotman BJ, Levivier M. Stereotactic radiosurgery for trigeminal neuralgia: a systematic review. J Neurosurg 2018; 130:733-757. [PMID: 29701555 DOI: 10.3171/2017.9.jns17545] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 09/11/2017] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The aims of this systematic review are to provide an objective summary of the published literature specific to the treatment of classical trigeminal neuralgia with stereotactic radiosurgery (RS) and to develop consensus guideline recommendations for the use of RS, as endorsed by the International Society of Stereotactic Radiosurgery (ISRS). METHODS The authors performed a systematic review of the English-language literature from 1951 up to December 2015 using the Embase, PubMed, and MEDLINE databases. The following MeSH terms were used in a title and abstract screening: "radiosurgery" AND "trigeminal." Of the 585 initial results obtained, the authors performed a full text screening of 185 studies and ultimately found 65 eligible studies. Guideline recommendations were based on level of evidence and level of consensus, the latter predefined as at least 85% agreement among the ISRS guideline committee members. RESULTS The results for 65 studies (6461 patients) are reported: 45 Gamma Knife RS (GKS) studies (5687 patients [88%]), 11 linear accelerator (LINAC) RS studies (511 patients [8%]), and 9 CyberKnife RS (CKR) studies (263 patients [4%]). With the exception of one prospective study, all studies were retrospective.The mean maximal doses were 71.1-90.1 Gy (prescribed at the 100% isodose line) for GKS, 83.3 Gy for LINAC, and 64.3-80.5 Gy for CKR (the latter two prescribed at the 80% or 90% isodose lines, respectively). The ranges of maximal doses were as follows: 60-97 Gy for GKS, 50-90 Gy for LINAC, and 66-90 Gy for CKR.Actuarial initial freedom from pain (FFP) without medication ranged from 28.6% to 100% (mean 53.1%, median 52.1%) for GKS, from 17.3% to 76% (mean 49.3%, median 43.2%) for LINAC, and from 40% to 72% (mean 56.3%, median 58%) for CKR. Specific to hypesthesia, the crude rates (all Barrow Neurological Institute Pain Intensity Scale scores included) ranged from 0% to 68.8% (mean 21.7%, median 19%) for GKS, from 11.4% to 49.7% (mean 27.6%, median 28.5%) for LINAC, and from 11.8% to 51.2% (mean 29.1%, median 18.7%) for CKR. Other complications included dysesthesias, paresthesias, dry eye, deafferentation pain, and keratitis. Hypesthesia and paresthesia occurred as complications only when the anterior retrogasserian portion of the trigeminal nerve was targeted, whereas the other listed complications occurred when the root entry zone was targeted. Recurrence rates ranged from 0% to 52.2% (mean 24.6%, median 23%) for GKS, from 19% to 63% (mean 32.2%, median 29%) for LINAC, and from 15.8% to 33% (mean 25.8%, median 27.2%) for CKR. Two GKS series reported 30% and 45.3% of patients who were pain free without medication at 10 years. CONCLUSIONS The literature is limited in its level of evidence, with only one comparative randomized trial (1 vs 2 isocenters) reported to date. At present, one can conclude that RS is a safe and effective therapy for drug-resistant trigeminal neuralgia. A number of consensus statements have been made and endorsed by the ISRS.
Collapse
Affiliation(s)
- Constantin Tuleasca
- 1Centre Hospitalier Universitaire Vaudois, Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center
- 4Signal Processing Laboratory (LTS 5), Ecole Politechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Jean Régis
- 11Department of Functional and Stereotactic Neurosurgery and Gamma Knife Unit, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Arjun Sahgal
- 5Department of Radiation Oncology, University of Toronto, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - Antonio De Salles
- 6Department of Neurosurgery, University of California, Los Angeles, California
| | - Motohiro Hayashi
- 7Department of Neurosurgery, Tokyo Women's Medical University, Tokyo
| | - Lijun Ma
- 8Department of Radiation Oncology, Kyoto University, Kyoto, Japan
- 9Department of Radiation Oncology, University of California, San Francisco, California
| | | | - Ian Paddick
- 14Queen Square Radiosurgery Centre, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Samuel Ryu
- 12Department of Radiation Oncology, Stony Brook University, Stony Brook, New York
| | - Ben J Slotman
- 13Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands; and
| | - Marc Levivier
- 10Department of Neurosurgery, Ruber International Hospital, Madrid, Spain
| |
Collapse
|
12
|
|
13
|
Latorzeff I, Debono B, Sol JC, Ménégalli D, Mertens P, Redon A, Muracciole X. Traitement de la névralgie essentielle du trijumeau par radiochirurgie stéréotaxique. Cancer Radiother 2012; 16 Suppl:S57-69. [DOI: 10.1016/j.canrad.2012.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Accepted: 01/23/2012] [Indexed: 10/28/2022]
|
14
|
Levitt MR, Ramanathan D, Vaidya SS, Hallam DK, Ghodke BV. Endovascular Palliation of AVM-Associated Intractable Trigeminal Neuralgia via Embolization of the Artery of the Foramen Rotundum. PAIN MEDICINE 2011; 12:1824-30. [DOI: 10.1111/j.1526-4637.2011.01277.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
15
|
CyberKnife stereotactic radiosurgical rhizotomy for refractory trigeminal neuralgia. J Clin Neurosci 2011; 18:1449-53. [DOI: 10.1016/j.jocn.2011.03.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 03/07/2011] [Accepted: 03/09/2011] [Indexed: 11/20/2022]
|
16
|
Park KJ, Kano H, Berkowitz O, Awan NR, Flickinger JC, Lunsford LD, Kondziolka D. Computed tomography-guided γ knife stereotactic radiosurgery for trigeminal neuralgia. Acta Neurochir (Wien) 2011; 153:1601-9. [PMID: 21538196 DOI: 10.1007/s00701-011-1026-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 04/06/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Gamma knife stereotactic radiosurgery (GKSR) is an effective minimally invasive option for the treatment of medically refractory trigeminal neuralgia (TN). Optimal targeting of the retrogasserian trigeminal nerve target requires thin-slice, high-definition stereotactic magnetic resonance imaging (MRI). The purpose of this study was to evaluate management outcomes in TN patients ineligible for MRI and who instead underwent GKSR using computed tomography (CT). METHODS The authors reviewed their experience with CT-guided GKSR in 21 patients (median age: 75 years) with idiopathic TN. Contraindications to MRI included implanted pacemakers (n = 16), aneurysm clips (n = 2), cochlea implants (n = 1), metallic vascular stents (n = 1) or severe obesity (weight of 163 kg, n = 1). Contrast-enhanced CT at 1- or 1.25-mm intervals was acquired in all patients. One patient also underwent CT cisternography. The median target dose for GKSR was 80 Gy. The median follow-up was 35 months after GKSR. Treatment outcomes were compared to 459 patients who underwent MRI-guided GKSR for TN at our institute in the same time interval. RESULTS Targeting of the trigeminal nerve guided by CT scan was feasible in all patients. Stereotactic frame titanium pin-related artifacts that interfered with full visualization of the trigeminal nerve were found in one patient who had the ipsilateral posterior pin placed near the inion. After GKSR, 90% of patients achieved initial pain relief that was adequate or better, with or without medication (Barrow Neurological Institute pain scores I-IIIb). Median time to pain relief was 2.6 weeks. Pain relief was maintained in 81% at 1 year, 66% at 2 years, and 46% at 5 years. Eight (42%) of 19 patients who achieved initial pain relief reported some recurrent pain at a median of 18 months after GKSR. Some degree of facial sensory dysfunction occurred in 19% of patients within 24 months of GKSR. These results are comparable to those of patients who had MRI-guided GKSR. CONCLUSIONS CT-guided GKSR provides a similar rate of pain relief as MRI-guided radiosurgery. The posterior pins should be placed at least 1 cm away from the inion to reduce pin and frame-related artifacts on the targeting CT scan. This study indicates that GKSR using CT targeting is appropriate for patients with medically refractory TN who are unsuitable for MRI.
Collapse
Affiliation(s)
- Kyung-Jae Park
- Department of Neurological Surgery, University of Pittsburgh, Center for Image-Guided Neurosurgery, Suite B-400, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | | | | | | | | | | | | |
Collapse
|
17
|
Parise M, Ribeiro CT, Vincent M, Gasparetto E. Small cerebellopontine angle cisterns inpatients with trigeminal neuralgia. J Neurosurg 2010; 112:900-1; author reply 901. [PMID: 20367385 DOI: 10.3171/2009.10.jns091517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|