Radiosurgery for trigeminal neuralgia using a linear accelerator with BrainLab system: report on initial experience...

Radiosurgery is an effective treatment for trigeminal neuralgia (TN) with minimal complications. Most experience is based on gamma knife radiosurgery (GKRS) and to a lesser extent on linear accelerators.

We report our initial experience in 17 patients with TN treated by an adapted linear accelerator using the BrainLab system. The trigeminal root entry zone immediately adjacent to the pons (target volume: 0.01-0.09 cm3, mean: 0.02 cm3) was targeted by use of a multileaf collimator to deliver 40-45 Gy to the 80% isodose (dose max 50-56 Gy). Median follow-up was 12 months (range: 1-60).

All patients reported some initial improvement in level of pain after treatment (mean time: 1 month). Initial pain responses were as follows: 6 patients (35%) had complete pain relief and required no medication, 6 (35%) had occasional pain but were off medication, and 5 (30%) experienced partial relief of pain but still required medication, usually in lower doses. Five patients (29%) who experienced initial pain relief had recurrences ranging from 4-13 months after procedure. There were no major or minor complications of radiosurgery except one case of mild facial itching.

Stereotactic radiosurgery using a linear accelerator appears to be effective and can be a favourable alternative to other procedures, including GKRS. The procedure is very safe and side effects are rare and minor. However, a randomised trial with a longer follow-up comparing radiosurgery to other surgical procedures is needed to assess the long term effectiveness of this treatment.