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. 2015;3(4):259-270.

Frame and frameless linear accelerator-based radiosurgery for idiopathic trigeminal neuralgia

Allan Y Chen  1   2 , Yen Hsieh  2 , Steffanie McNair  1 , Qijuan Li  1 , Kevin Y Xu  1 , Conrad Pappas  3
Affiliations

Frame and frameless linear accelerator-based radiosurgery for idiopathic trigeminal neuralgia

Allan Y Chen et al. J Radiosurg SBRT. 2015.

Abstract

Purpose: We report outcome of linear accelerator (Linac)-based stereotactic radiosurgery (SRS) for trigeminal neuralgia (TGN) utilizing rigid head frame (RF) and facemask (FM) immobilization.Method: From November 2008 to October 2012, 48 patients with idiopathic TGN underwent primary SRS by a dedicated Linac. RF immobilization was utilized for 34 patients, and frameless image-guided radiosurgery (IGRS) with FM immobilization was performed in 14 patients. Treatment outcome was assessed by patient interviews with a 7-item questionnaire.

Results: Sub-millimeter targeting accuracy (0.71±0.31 mm) was recorded for frameless IGRS by a novel hidden-target phantom method. With a follow-up of 26 months, significant pain relief was recorded in 43 (89%) patients, including 26 (54%) complete and 17 (35%) partial responses; with a significant reduction of 2.4±1.3 points (p < 0.01) on the 5-point Barrow Neurological Institute pain scale. No significant pain relief difference (p = 0.23) was detected between patients immobilized by RF and FM. Notable pin site problems were reported in 9 (26%) of 34 patients immobilized by RF.

Conclusion: Frameless IGRS with FM immobilization is more patient friendly and can achieve as excellent treatment outcome as with RF immobilization for idiopathic TGN.

Keywords: frameless image-guided radiosurgery.; linear accelerator; radiosurgery; targeting accuracy; trigeminal neuralgia.

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Figures

Figure 1
Figure 1
Targeting accuracy of frameless image-guided radiosurgery (IGRS) assessed by a hidden-target phantom test. (A) The modified Rando Head & Neck Phantom. (B) Frameless IGRS delivery to the phantom. (C) Examples of exposed Gafchromic films from the test. (D) Targeting deviations of 39 consecutive tests by measuring the absolute distance between planned isocenter (pricked point target) and delivered isocenter (center of the dark spot generated by radiation).
Figure 1
Figure 1
Targeting accuracy of frameless image-guided radiosurgery (IGRS) assessed by a hidden-target phantom test. (A) The modified Rando Head & Neck Phantom. (B) Frameless IGRS delivery to the phantom. (C) Examples of exposed Gafchromic films from the test. (D) Targeting deviations of 39 consecutive tests by measuring the absolute distance between planned isocenter (pricked point target) and delivered isocenter (center of the dark spot generated by radiation).
Figure 1
Figure 1
Targeting accuracy of frameless image-guided radiosurgery (IGRS) assessed by a hidden-target phantom test. (A) The modified Rando Head & Neck Phantom. (B) Frameless IGRS delivery to the phantom. (C) Examples of exposed Gafchromic films from the test. (D) Targeting deviations of 39 consecutive tests by measuring the absolute distance between planned isocenter (pricked point target) and delivered isocenter (center of the dark spot generated by radiation).
Figure 1
Figure 1
Targeting accuracy of frameless image-guided radiosurgery (IGRS) assessed by a hidden-target phantom test. (A) The modified Rando Head & Neck Phantom. (B) Frameless IGRS delivery to the phantom. (C) Examples of exposed Gafchromic films from the test. (D) Targeting deviations of 39 consecutive tests by measuring the absolute distance between planned isocenter (pricked point target) and delivered isocenter (center of the dark spot generated by radiation).
Figure 2
Figure 2
Asymmetric 7-arc technique reduces brainstem dose. (A) Asymmetric 7-arc technique. (B) Symmetric 7-arc technique. Brainstem mean dose (C) and maximum dose (D) are based on simulated plans for 5 patients.
Figure 2
Figure 2
Asymmetric 7-arc technique reduces brainstem dose. (A) Asymmetric 7-arc technique. (B) Symmetric 7-arc technique. Brainstem mean dose (C) and maximum dose (D) are based on simulated plans for 5 patients.
Figure 2
Figure 2
Asymmetric 7-arc technique reduces brainstem dose. (A) Asymmetric 7-arc technique. (B) Symmetric 7-arc technique. Brainstem mean dose (C) and maximum dose (D) are based on simulated plans for 5 patients.
Figure 2
Figure 2
Asymmetric 7-arc technique reduces brainstem dose. (A) Asymmetric 7-arc technique. (B) Symmetric 7-arc technique. Brainstem mean dose (C) and maximum dose (D) are based on simulated plans for 5 patients.
Figure 3
Figure 3
Pain relief outcome based on the 5-point Barrow Neurological Institute (BNI) pain scale. (A) All 48 patients. (B) Patients immobilized by rigid head frame (RF). (C) Patients immobilized by facemask (FM).
Figure 3
Figure 3
Pain relief outcome based on the 5-point Barrow Neurological Institute (BNI) pain scale. (A) All 48 patients. (B) Patients immobilized by rigid head frame (RF). (C) Patients immobilized by facemask (FM).
Figure 3
Figure 3
Pain relief outcome based on the 5-point Barrow Neurological Institute (BNI) pain scale. (A) All 48 patients. (B) Patients immobilized by rigid head frame (RF). (C) Patients immobilized by facemask (FM).
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