Initial clinical experience with surface image guided (SIG) radiosurgery for trigeminal neuralgia

• DOI: 10.21037/2921
• Publication Date: 2014-08-20
• Authors: Anthony J. Paravati; R Manger; Jasmine Nguyen; Sofia Olivares; Gwe-Ya Kim; Kevin T. Murphy

Background: To evaluate the initial clinical experience with a surface image guided technique for stereotactic radiosurgery using minimal patient immobilization and real-time motion monitoring treatment of trigeminal neuralgia (TN). Methods: The study describes first seven TN patients treated this technique. Head positioning was achieved patient-specific head mold made out expandable foam that conforms to patient’s occiput. face each left open unobstructed maximal comfort. region interest consisting forehead, eyes, nose, temporal bones monitored during video imaging system (Vision RT Ltd., London, UK). Initial setup performed planning computed tomographic (CT) scan. confirmed finalized cone-beam CT (CBCT) KV X-ray images prior treatment. dedicated linear accelerator used delivery Trilogy (Varian Medical Systems, Palo Alto, CA) 5 mm collimator 13 arcs. Patients were cameras software, equipped beam stop mechanism if found exceed specified tolerance. Results: Seven underwent single fraction dose range 80-90 Gy guidance. All experienced pain relief. Four complete resolution pain. At median follow-up 31.4 months, two developed recurrence. One reported intermittent facial numbness after SRS which resolved by 9 months post-treatment. Conclusions: real time has proven be safe effective in small cohort TN. our knowledge is series describing use technology Patient compliance important, appears improve given speed comfort An additional degree semi-rigid may required some patients.