Dosimetric comparison in various stereotactic radiosurgery modalities for trigeminal neuralgia treatment

Trigeminal neuralgia (TN) is characterized by severe facial pain and is treated with medications, surgery, percutaneous procedures, and stereotactic radiosurgery (SRS). The Gamma Knife (GK) has historically been the gold standard for SRS in TN, with alternatives such as the CyberKnife (CK) and standard linear accelerator (LA) having recently emerged. This study compared GK, CK, and LA treatments for TN via dosimetric analysis. Twenty patients (10 right- and 10 left-sided) with TN were planned in the three modalities. Dosimetric parameters, including D_Max, D_Min, D_Mean, D_98%, D_90%, D_50%, D_30%, and V_4Gy, were evaluated. The statistical significance was assessed using paired t tests. The CK and LA plans achieved a 60 Gy target coverage comparable to the GK plan. The GK plan exhibited superior brain stem sparing and lower V_4Gy compared with CK (p = 0.0013) and LA (p = 0.0001). Significant differences in D_Min, D_98%, D_90%, D_50%, and D_30% were observed between GK and CK (p < 0.05) and GK and LA (p < 0.05), but not for the CK-LA comparisons. The brain stem dose parameters (D_0.03 cc, D_1%, and D_2%) were significantly lower in the GK plan (p < 0.05). The GK exhibited better normal tissue sparing and brain stem dose distribution than CK and LA, attributable partly to its higher beam count. CK and LA require more intricate planning times. Despite the established efficacy of GK, CK and LA offer viable alternatives, underscoring the need for further research on the clinical outcomes of TN treatment in the respective modalities.