Frame and frameless linear accelerator-based radiosurgery for idiopathic trigeminal neuralgia

Area of Science:

• Neurosurgery
• Radiation Oncology

Background:

• Trigeminal neuralgia (TGN) is a debilitating neuropathic pain condition.
• Stereotactic radiosurgery (SRS) is an effective treatment for TGN.

Purpose of the Study:

• To compare the outcomes of linear accelerator (Linac)-based SRS for TGN using rigid head frame (RF) and facemask (FM) immobilization.
• To evaluate the efficacy and safety of frameless image-guided radiosurgery (IGRS) with FM immobilization.

Main Methods:

• Retrospective study of 48 idiopathic TGN patients treated with primary SRS between November 2008 and October 2012.
• 34 patients received RF immobilization, while 14 patients underwent frameless IGRS with FM immobilization.
• Treatment outcomes assessed via patient interviews using a 7-item questionnaire.

Main Results:

• Sub-millimeter targeting accuracy achieved with frameless IGRS.
• 89% of patients experienced significant pain relief (54% complete, 35% partial) after a 26-month follow-up.
• No significant difference in pain relief between RF and FM immobilization groups (p=0.23).
• RF immobilization led to pin site problems in 26% of patients.

Conclusions:

• Frameless IGRS with FM immobilization provides excellent pain relief for TGN, comparable to RF immobilization.
• Frameless IGRS with FM immobilization is more patient-friendly and associated with fewer complications.