Stereotactic radiosurgery for trigeminal neuralgia utilizing the BrainLAB Novalis system

Area of Science:

• Neurosurgery
• Radiation Oncology

Background:

• Trigeminal neuralgia (TN) is a debilitating condition often treated with invasive procedures.
• Stereotactic radiosurgery (SRS) offers a minimally invasive treatment option for TN.
• Limited data exists on image-guided linear accelerator-based SRS for TN compared to Cobalt-based systems.

Purpose of the Study:

• To evaluate the initial experience and efficacy of the BrainLAB Novalis stereotactic system for radiosurgical treatment of trigeminal neuralgia.
• To assess treatment outcomes and complications in patients undergoing SRS for TN.

Main Methods:

• 20 patients with TN were treated using the BrainLAB Novalis stereotactic system between July 2004 and February 2007.
• Procedures involved thin-cut MRI (1.5 mm) fused with CT, and 3D FIESTA MRI for improved target delineation.
• Median prescribed dose was 90 Gy, with median brainstem doses of 2.3 Gy (1.0 cc) and 13.5 Gy (0.1 cc).

Main Results:

• 95% of patients reported pain improvement at a median follow-up of 14.2 months.
• 40% achieved complete pain relief (BNI Grade I), and 10% had occasional pain while off medication (BNI Grade II).
• Facial numbness occurred in 35% of patients; no other severe complications were reported.

Conclusions:

• Stereotactic radiosurgery with the BrainLAB Novalis system is a safe and effective treatment for trigeminal neuralgia.
• The findings support the use of image-guided stereotactic linear accelerators for TN radiosurgery.
• This study provides valuable data for centers adopting advanced radiosurgical technologies for TN treatment.