Linear Accelerator Mask-Based Radiosurgery for Trigeminal Neuralgia: Prospective Evaluation of 50 Patients

Area of Science:

• Neurosurgery
• Radiation Oncology
• Medical Physics

Background:

• Trigeminal neuralgia (TN) poses challenges for patients unresponsive to medication.
• Treatment options include microvascular decompression, percutaneous procedures, and radiosurgery.
• Radiosurgery for TN lacks standardized protocols for target definition, dosimetry, and delivery.

Purpose of the Study:

• To evaluate the safety and efficacy of image-guided radiosurgery for trigeminal neuralgia.
• To assess treatment response, pain recurrence, and adverse effects in TN patients undergoing radiosurgery.

Main Methods:

• Prospective observational study of TN patients treated with 90 Gy radiosurgery.
• Utilized mask immobilization, Novalis couch positioning, and ExacTrac for image guidance and motion monitoring.
• Analyzed treatment response, pain characteristics, recurrence rates, and adverse events.

Main Results:

• 91% of patients achieved initial treatment response with a median latency of 15 days.
• Recurrence occurred in 22% (minor) and 34% (major) of patients, but pain intensity/frequency remained reduced.
• Sustained response was observed in 60% of patients at last follow-up; no severe treatment-related morbidity or mortality was reported.

Conclusions:

• Mask-based immobilization and image-guided radiosurgery offer a safe and effective treatment for drug-resistant trigeminal neuralgia.
• This technique is suitable for idiopathic, secondary, or classical TN patients who are not candidates for microvascular decompression.
• The study highlights the potential of advanced radiosurgical techniques for managing refractory TN.