Radiocirugía con acelerador lineal mediante máscara para la neuralgia del trigémino. Evaluación prospectiva de 50...

Trigeminal neuralgia resistant to pharmacological treatment can be treated with microvascular decompression, percutaneous procedures, or radiosurgery. Regarding radiosurgery, there is variability in target definition, dose selection, radiation delivery and positioning and immobilization.

This observational prospective study included TN patients treated with 90 Gy prescribed to an anterior cisternal isocenter, delivered with a TrueBeam LinAc, under mask-immobilization, Novalis couch positioning and ExacTrac X-ray and infrared positioning and motion monitoring. Treatment response, intensity and frequency of pain, presence of recurrences and adverse effects were analyzed.

91% of patients responded to treatment, with a median latency of 15 days (IQR 41). 9 (22%) patients experienced minor recurrence at a median time of 7 months (IQR 3), and 14 (34%) patients experienced a major recurrence at a median time of 12 months (IQR 19). After recurrence, both frequency and intensity of episodes remained significantly lower than pre-treatment. At last follow-up, response was maintained in 25 (60%) patients. No radiosurgery - related severe morbidity, neither mortality, was found.

Mask-based immobilization combined with image-guided radiation delivered by rotating gantry-based LinAc system provides a safe and effective radiosurgical treatment for TN, which is indicated for drug-resistant idiopathic or secondary TN patients and for drug-resistant classical TN patients who are not candidates for MVD.