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 Burchiel, Joseph C. Christiano, Douglas Kondziolka, William A. Friedman

Research output: Contribution to journalArticle

57 Citations (Scopus)

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
StatePublished - Oct 1 2003
Externally publishedYes

Fingerprint

Trigeminal Neuralgia
Radiosurgery
Hypesthesia
Brain Stem
Pain
Particle Accelerators
Therapeutics
Software
Recurrence

Keywords

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

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Goss, B. W., Frighetto, L., DeSalles, A. A. F., Smith, Z., Solberg, T., Selch, M., ... Friedman, W. A. (2003). Linear accelerator radiosurgery using 90 gray for essential trigeminal neuralgia: Results and dose volume histogram analysis. Neurosurgery, 53(4), 823-830.

Linear accelerator radiosurgery using 90 gray for essential trigeminal neuralgia : Results and dose volume histogram analysis. / Goss, Bryan W.; Frighetto, Leonardo; DeSalles, Antonio A F; Smith, Zachary; Solberg, Timothy; Selch, Michael; Pollock, Bruce E.; Régis, Jean; Massager, Nicolas; Levivier, Marc; Burchiel, Kim; Christiano, Joseph C.; Kondziolka, Douglas; Friedman, William A.

In: Neurosurgery, Vol. 53, No. 4, 01.10.2003, p. 823-830.

Research output: Contribution to journalArticle

Goss, BW, Frighetto, L, DeSalles, AAF, Smith, Z, Solberg, T, Selch, M, Pollock, BE, Régis, J, Massager, N, Levivier, M, Burchiel, K, Christiano, JC, Kondziolka, D & Friedman, WA 2003, 'Linear accelerator radiosurgery using 90 gray for essential trigeminal neuralgia: Results and dose volume histogram analysis', Neurosurgery, vol. 53, no. 4, pp. 823-830.
Goss BW, Frighetto L, DeSalles AAF, Smith Z, Solberg T, Selch M et al. Linear accelerator radiosurgery using 90 gray for essential trigeminal neuralgia: Results and dose volume histogram analysis. Neurosurgery. 2003 Oct 1;53(4):823-830.
Goss, Bryan W. ; Frighetto, Leonardo ; DeSalles, Antonio A F ; Smith, Zachary ; Solberg, Timothy ; Selch, Michael ; Pollock, Bruce E. ; Régis, Jean ; Massager, Nicolas ; Levivier, Marc ; Burchiel, Kim ; Christiano, Joseph C. ; Kondziolka, Douglas ; Friedman, William A. / Linear accelerator radiosurgery using 90 gray for essential trigeminal neuralgia : Results and dose volume histogram analysis. In: Neurosurgery. 2003 ; Vol. 53, No. 4. pp. 823-830.
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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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AU - Smith, Zachary

AU - Solberg, Timothy

AU - Selch, Michael

AU - Pollock, Bruce E.

AU - Régis, Jean

AU - Massager, Nicolas

AU - Levivier, Marc

AU - Burchiel, Kim

AU - Christiano, Joseph C.

AU - Kondziolka, Douglas

AU - Friedman, William A.

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N2 - 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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KW - Linear accelerator

KW - Stereotactic radiosurgery

KW - Trigeminal neuralgia

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