Radiocirurgia

Abstract The objective of the present study was the evaluation of outcome in 130 patients with essential trigeminal neuralgia, who were treated using Leksell Gamma Knife model C with automatic positioning system and followed at least 24 months thereafter. Radiosurgery was guided by fused thin-sliced magnetic resonance (MR) and “bone window” computed tomographic (CT) images. In all cases, retrogasserian part of the trigeminal nerve at the level of trigeminal incisura was selected as a target, and one 4-mm collimator was used for delivery of the maximum irradiation dose of 90 Gy. The coordinates of the isocenter were adjusted for positioning of the nerve in the center of 80% isodose area, and were corrected in each individual case with regard to presence of distortion artifacts on MR images. Initial relief of the typical paroxysmal facial pain was marked in 127 patients (98%) within a median interval of 3 weeks after treatment. However, in 23 patients the pain re-appeared later on. Overall, at the time of the last follow-up 112 patients (86%) were pain-free, including 86 who remained both pain- and medication-free after initial radiosurgery. In 31 cases (24%), treatment was complicated by facial hypesthesia and/or paresthesia. In conclusion, radiosurgery of essential trigeminal neuralgia results in a high rate of initial pain relief, but pain recurrences and associated complications are not uncommon. The outcome may be influenced by various technical nuances; therefore, treatment should be preferably done in specialized clinical centers with sufficient expertise in the management of this disorder.

• Content Type Journal Article
• Pages 1-12
• DOI 10.1007/s10143-011-0330-9
• Authors
  • Motohiro Hayashi, Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
  • Mikhail Chernov, Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
  • Noriko Tamura, Department of Neurosurgery, Neurological Institute, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
  • Takaomi Taira, Department of Neurosurgery, Neurological Institute, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
  • Masahiro Izawa, Department of Neurosurgery, Neurological Institute, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
  • Shoji Yomo, Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
  • Mariko Nagai, Department of Neurosurgery, Neurological Institute, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
  • Cheng-Siu Chang, Department of Neurosurgery, Show Chwan Memorial Hospital, Changhua, Taiwan
  • Pavel Ivanov, Department of Radiosurgery, International Institute of the Biological Systems, Saint Petersburg, Russia
  • Manabu Tamura, Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
  • Yoshihiro Muragaki, Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
  • Yoshikazu Okada, Department of Neurosurgery, Neurological Institute, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
  • Hiroshi Iseki, Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
  • Kintomo Takakura, Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan

• Journal Neurosurgical Review
• Online ISSN 1437-2320
• Print ISSN 0344-5607

http://www.springerlink.com/content/178487g63281w013/

Original Page: http://thejns.org/doi/abs/10.3171/2011.6.JNS102129?ai=ru&mi=0&af=R

Journal of Neurosurgery, Volume 0, Issue 0, Page 1-5, Ahead of Print.

Anuj V. Peddada, M.D., D. James Sceats, M.D., Gerald A. White, M.S., Gyongyver Bulz, M.S., Greg L. Gibbs, M.S., Barry Switzer, B.S., Susan Anderson, R.N., and Alan T. Monroe, M.D. This case report of 74-year-old man with trigeminal neuralgia is presented to underscore the importance of evaluating the entire treatment plan, especially when delivering large doses where even a low percentage of the prescription dose can contribute a substantial dose to an unintended target. The patient was treated using the CyberKnife stereotactic radiosurgery system utilizing a nonisocentric beam treatment plan with a 5-mm fixed collimator generating 111 beams to deliver 6000 cGy to the 79% isodose line with a maximum dose of 7594 cGy to the target. Two weeks after treatment the patient’s trigeminal neuralgia symptoms resolved; however, the patient developed oral mucositis due to the treatment. This case report reviews the cause of mucositis and makes recommendations on how to prevent unintended targets from receiving treatment.

Stereotactic radiosurgery for glossopharyngeal neuralgia: preliminary report of 5 cases

Journal of Neurosurgery, Volume 0, Issue 0, Page 1-4, Ahead of Print.

Bruce E. Pollock, M.D., and Christopher J. Boes, M.D.

Object

Glossopharyngeal neuralgia (GPN) is a rare pain disorder characterized by severe, stabbing pain of the ear, posterior tongue, and throat. The authors report their early experience of using stereotactic radiosurgery (SRS) as an alternative to posterior fossa surgery for patients with medically resistant GPN.

Methods

Five patients (3 men, 2 woman) with medically resistant GPN underwent Gamma Knife surgery. The radiosurgical target was the distal portion of the glossopharyngeal and vagus nerves at the jugular foramen (glossopharyngeal meatus). The maximum radiation dose in all cases was 80 Gy. The median follow-up after radiosurgery was 13 months (range 2–19 months).

Results

Three patients became pain-free at 2 days, 3 days, and 2 weeks, respectively, and were able to discontinue the medications taken preoperatively for their pain. None of these patients have suffered recurrent pain since becoming pain free. Two patients experienced no benefit from the procedure and underwent posterior fossa surgery 2 and 5 months after SRS. Both of these patients continued to have pain after posterior fossa surgery. One of these patients was later discovered to have a head and neck cancer as the cause of his pain. No patient developed hoarseness or dysphagia after radiosurgery.

Conclusions

This preliminary experience demonstrates that SRS is an option for patients with medically resistant GPN. Additional follow-up and a larger number of patients are needed to demonstrate the long-term safety and optimal radiation dosimetry for this indication.

http://thejns.org/doi/abs/10.3171/2011.5.JNS1133?ai=ru&mi=0&af=R

Sent to you by Júlio Pereira via Google Reader:

CyberKnife radiosurgery for trigeminal neuralgia: unanticipated iatrogenic effect following successful treatment

via Journal of Neurosurgery: Journal of Neurosurgery: Table of Contents by jnsonline@thejns.org (Anuj V. Peddada et al) on 7/15/11

Journal of Neurosurgery, Volume 0, Issue 0, Page 1-5, Ahead of Print.

Anuj V. Peddada, M.D., D. James Sceats, M.D., Gerald A. White, M.S., Gyongyver Bulz, M.S., Greg L. Gibbs, M.S., Barry Switzer, B.S., Susan Anderson, R.N., and Alan T. Monroe, M.D. This case report of 74-year-old man with trigeminal neuralgia is presented to underscore the importance of evaluating the entire treatment plan, especially when delivering large doses where even a low percentage of the prescription dose can contribute a substantial dose to an unintended target. The patient was treated using the CyberKnife stereotactic radiosurgery system utilizing a nonisocentric beam treatment plan with a 5-mm fixed collimator generating 111 beams to deliver 6000 cGy to the 79% isodose line with a maximum dose of 7594 cGy to the target. Two weeks after treatment the patient’s trigeminal neuralgia symptoms resolved; however, the patient developed oral mucositis due to the treatment. This case report reviews the cause of mucositis and makes recommendations on how to prevent unintended targets from receiving treatment.

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