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Trigeminal Neuralgia

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CyberKnife NeuroRadiosurgery

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Abstract

Trigeminal neuralgia (TN) is the most common cranio-facial pain syndrome, with an incidence of up to 5 in 100,000. Long-term medical treatment is commonly required, with up to 10% of cases suffering from adverse drug-related events. In 1951, Lars Leksell pioneered the application of stereotactic irradiation for the treatment of TN, which may now achieve up to 90% pain control at 1 year and 60% at 3–5 years.

Radiosurgical treatment targets either the nerve’s emergence (the root entry zone) or the retrogasserian portion of the nerve (pars triangularis). Targeting the latter may reduce the risk of complications, but requires a higher maximum dose to obtain optimal results. Generally speaking, radiosurgical treatment achieves optimal results in patients receiving high doses of radiation ranging from 70 to 90 Gy. Hypoesthesia and facial numbness are frequently observed after high-dose trigeminal irradiation. Mild hypoesthesia is acceptable and is considered by many an efficacy endpoint of the procedure. Bothersome facial numbness is relatively rare. Sensitive trigeminal disturbances and paresthesia after treatment have been reported to range, respectively, 6%–54% and 0%–17%. The prescribed dose and brainstem-delivered dose are correlated with the subsequent rate of sensitive trigeminal disturbances. CyberKnife frameless non-isocentric radiosurgery is an emerging and non-invasive treatment for TN. Because of the non-isocentric geometry of radiation beams delivery, CyberKnife technique offers the possibility of homogeneous irradiation of an extended segment of the trigeminal nerve, so introducing some new concepts for the radiosurgical treatment of TN. Clinical results of CyberKnife radiosurgery seem to be satisfactory. Here, we review the basics of radiosurgery for TN and present a detailed analysis of the technique using the CyberKnife frameless system.

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Authors and Affiliations

  1. Brain Radiosurgery, Cyberknife Center, CDI, Milan, Italy

    Pantaleo Romanelli

  2. Alma Mater Studiorum University of Bologna, Bologna, Italy

    Alfredo Conti

  3. IRCCS ISNB Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy

    Alfredo Conti

  4. Department of Neurosurgery, Charité Faculty of Medicine, Berlin, Germany

    Alfredo Conti

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  1. Pantaleo Romanelli
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Correspondence to Pantaleo Romanelli .

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Editors and Affiliations

  1. Associate Professor of Neurosurgery, Alma Mater Studiorum University of Bologna, Bologna, Italy

    Alfredo Conti

  2. Scientific Director, AB Medica, Milano, Italy

    Pantaleo Romanelli

  3. Assistant Professor, Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Evangelos Pantelis

  4. Associate Professor, Department of Radiation Oncology, Stanford University Cancer Center, Stanford, CA, USA

    Scott G. Soltys

  5. Associate Professor, Department of Neurosurgery and Radiosurgery Center, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea (Republic of)

    Young Hyun Cho

  6. Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Michael Lim

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Romanelli, P., Conti, A. (2020). Trigeminal Neuralgia. In: Conti, A., Romanelli, P., Pantelis, E., Soltys, S., Cho, Y., Lim, M. (eds) CyberKnife NeuroRadiosurgery . Springer, Cham. https://doi.org/10.1007/978-3-030-50668-1_47

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