Frameless image-guided radiosurgery for trigeminal neuralgia

Area of Science:

• Neurosurgery
• Radiation Oncology
• Pain Management

Background:

• Frameless image-guided radiosurgery (IGRS) is a recognized noninvasive treatment for trigeminal neuralgia (TN).
• This study specifically evaluates frameless IGRS for patients with medically refractory TN.

Purpose of the Study:

• To assess the efficacy and safety of frameless IGRS in treating patients with trigeminal neuralgia.
• To evaluate pain relief and reduction in medication requirements post-treatment.

Main Methods:

• Retrospective review of 20 patients with TN treated with frameless IGRS (March 2012 - December 2013).
• Pain assessment using the Barrow Neurological Institute (BNI) scoring system.
• Measurement of setup and intrafraction uncertainties; median follow-up of 32 months.

Main Results:

• All patients presented with severe pain (BNI Grade IV or V) pre-treatment.
• Mean intrafraction shift was 0.43 mm; maximum was 0.95 mm.
• At follow-up, 40% were pain-free without medication (BNI 1 or 2), 55% were pain-free with medication (BNI 3), and 5% had no relief (BNI 5).
• Patients without prior surgery showed significantly higher odds of pain relief (OR 14.9, P=0.0408).

Conclusions:

• Frameless IGRS is a viable noninvasive option for medically refractory trigeminal neuralgia.
• Clinical outcomes are comparable to traditional frame-based stereotactic radiosurgery (SRS).
• This technique offers effective pain management with minimal uncertainty.