Linear accelerator-based radiosurgery for trigeminal neuralgia: comparative outcomes of frame-based and mask-based...

Area of Science:

• Neurosurgery
• Radiation Oncology
• Pain Management

Background:

• Stereotactic radiosurgery (SRS) is a key treatment for trigeminal neuralgia (TN).
• Optimizing outcomes requires precise targeting.
• Comparing different SRS techniques is crucial for improving patient care.

Purpose of the Study:

• To compare the efficacy and safety of mask-based 4-mm cone versus frame-based 5-mm cone SRS for TN.
• To evaluate long-term pain relief and toxicity profiles between the two techniques.

Main Methods:

• Retrospective review of 234 patients with TN treated with SRS between 1996 and 2019.
• Assessment of pain relief using the Barrow Neurological Institute (BNI) pain score.
• Evaluation of facial numbness using the BNI facial hypesthesia scale.

Main Results:

• Frame-based 5-mm cone SRS showed a higher initial pain control rate (93.4%) compared to mask-based 4-mm cone SRS (87.6%).
• Long-term pain control (≥ 24 months) was significantly better with frame-based SRS (89.9%) versus mask-based SRS (77.8%; p=0.02).
• Pain recurrence was less frequent and occurred later with frame-based SRS.

Conclusions:

• Frame-based 5-mm cone SRS provides superior long-term pain relief for TN compared to mask-based 4-mm cone SRS.
• Toxicity profiles, including facial hypesthesia, were similar between the two techniques.
• Frame-based SRS is recommended for better long-term outcomes in TN patients.