Vol 54, No 1 (2020)
Review article
Published online: 2020-01-23
Submitted: 2019-11-05
Accepted: 2020-01-13
Get Citation

Effectiveness and safety of CyberKnife radiosurgery in treatment of trigeminalgia — experiences of Polish neurological and oncological centres

Wiesław Bal, Beata Łabuz- Roszak, Rafał Tarnawski, Anetta Lasek-Bal
DOI: 10.5603/PJNNS.a2020.0009
·
Pubmed: 31976542
·
Neurol Neurochir Pol 2020;54(1):28-32.

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Vol 54, No 1 (2020)
Review article
Published online: 2020-01-23
Submitted: 2019-11-05
Accepted: 2020-01-13

Abstract

Trigeminal neuralgia (TN) is one of the most common cranial neuropathies. Pathologies located alongside the long nerve can also cause its mechanical compression or secondary involvement in the inflammatory process, and thus cause pain. TN is characterised by severe paroxysmal unilateral facial pain in the innervation area of branches I-III of the nerve V when provoked by light touch or slight movement. Multiple therapeutic methods are available, but most of them yield unsatisfactory results. According to guidelines (AAN and EFNS) the first-line therapy in trigeminalgia is carbamazepine/oxcarbazepine, and if there is a poor response — surgical treatment [1]. The array of surgical options includes percutaneous retrogasserian glycerol injection, radiofrequency thermocoagulation, balloon decompression, thermal rhizotomy, and stereotactic radiosurgery [2–4]. This paper presents our own experiences with CyberKnife (CK), a new type of radiosurgical (RS) treatment of 64 TN patients. Conclusions. CyberKnife radiotherapy is characterised by high efficacy in 80% of patients with trigeminalgia, minimal invasiveness, and subsiding mild side effects. Radioablation of nerve V root in patients with neuralgia allows us to entirely stop antiepileptic therapy or reduce its doses, which in turn reduces the risk of potential side effects. CyberKnife can be a therapeutic option in those patients who have been offered ineffective therapies, or treatments with limited efficacy, and/or in older patients with comorbidities.

Abstract

Trigeminal neuralgia (TN) is one of the most common cranial neuropathies. Pathologies located alongside the long nerve can also cause its mechanical compression or secondary involvement in the inflammatory process, and thus cause pain. TN is characterised by severe paroxysmal unilateral facial pain in the innervation area of branches I-III of the nerve V when provoked by light touch or slight movement. Multiple therapeutic methods are available, but most of them yield unsatisfactory results. According to guidelines (AAN and EFNS) the first-line therapy in trigeminalgia is carbamazepine/oxcarbazepine, and if there is a poor response — surgical treatment [1]. The array of surgical options includes percutaneous retrogasserian glycerol injection, radiofrequency thermocoagulation, balloon decompression, thermal rhizotomy, and stereotactic radiosurgery [2–4]. This paper presents our own experiences with CyberKnife (CK), a new type of radiosurgical (RS) treatment of 64 TN patients. Conclusions. CyberKnife radiotherapy is characterised by high efficacy in 80% of patients with trigeminalgia, minimal invasiveness, and subsiding mild side effects. Radioablation of nerve V root in patients with neuralgia allows us to entirely stop antiepileptic therapy or reduce its doses, which in turn reduces the risk of potential side effects. CyberKnife can be a therapeutic option in those patients who have been offered ineffective therapies, or treatments with limited efficacy, and/or in older patients with comorbidities.

Get Citation

Keywords

trigeminal neuralgia, CyberKnife, radiosurgery

About this article
Title

Effectiveness and safety of CyberKnife radiosurgery in treatment of trigeminalgia — experiences of Polish neurological and oncological centres

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 54, No 1 (2020)

Pages

28-32

Published online

2020-01-23

DOI

10.5603/PJNNS.a2020.0009

Pubmed

31976542

Bibliographic record

Neurol Neurochir Pol 2020;54(1):28-32.

Keywords

trigeminal neuralgia
CyberKnife
radiosurgery

Authors

Wiesław Bal
Beata Łabuz- Roszak
Rafał Tarnawski
Anetta Lasek-Bal

References (24)
  1. Bendtsen L, Zakrzewska JM, Abbott J, et al. European Academy of Neurology guideline on trigeminal neuralgia. Eur J Neurol. 2019; 26(6): 831–849.
  2. Zakrzewska JM, Akram H. Neurosurgical interventions for the treatment of classical trigeminal neuralgia. Cochrane Database Syst Rev. 2011(9): CD007312.
  3. Sharim J, Lo WL, Kim W, et al. Radiosurgical target distance from the root entry zone in the treatment of trigeminal neuralgia. Pract Radiat Oncol. 2017; 7(4): 221–227.
  4. Debono B, Lotterie JA, Sol JC, et al. Dedicated Linear Accelerator Radiosurgery for Classic Trigeminal Neuralgia: A Single-Center Experience with Long-Term Follow-Up. World Neurosurg. 2019; 121: e775–e785.
  5. Zerna C, Yu AYX, Modi J, et al. Association of White Matter Hyperintensities With Short-Term Outcomes in Patients With Minor Cerebrovascular Events. Stroke. 2018; 49(4): 919–923.
  6. Erdine S, Ozyalcin NS, Cimen A, et al. Comparison of pulsed radiofrequency with conventional radiofrequency in the treatment of idiopathic trigeminal neuralgia. Eur J Pain. 2007; 11(3): 309–313.
  7. Devor M, Govrin-Lippmann R, Rappaport ZH. Mechanism of trigeminal neuralgia: an ultrastructural analysis of trigeminal root specimens obtained during microvascular decompression surgery. J Neurosurg. 2002; 96(3): 532–543.
  8. Dib-Hajj SD, Geha P, Waxman SG. Sodium channels in pain disorders: pathophysiology and prospects for treatment. Pain. 2017; 158 Suppl 1: S97–S9S107.
  9. Mohammed H, Rimondini L, Rocchetti V. Molecular basis of trigeminal nerve disorders and healing. Eur Rev Med Pharmacol Sci. 2018; 22(17): 5755–5764.
  10. Tanaka BS, Zhao P, Dib-Hajj FB, et al. A gain-of-function mutation in Nav1.6 in a case of trigeminal neuralgia. Mol Med. 2016; 22: 338–348.
  11. Harsha KJ, Kesavadas C, Chinchure S, et al. Imaging of vascular causes of trigeminal neuralgia. J Neuroradiol. 2012; 39(5): 281–289.
  12. Dvorak T, Finn A, Price LL, et al. Retreatment of trigeminal neuralgia with Gamma Knife radiosurgery: is there an appropriate cumulative dose? Clinical article. J Neurosurg. 2009; 111(2): 359–364.
  13. Herman J, Petit J, Amin P, et al. Repeat gamma knife radiosurgery for refractory or recurrent trigeminal neuralgia: treatment outcomes and quality-of-life assessment. International Journal of Radiation Oncology*Biology*Physics. 2004; 59(1): 112–116.
  14. Kimball BY, Sorenson JM, Cunningham D. Repeat Gamma Knife surgery for trigeminal neuralgia: long-term results. J Neurosurg. 2010; 113 Suppl: 178–183.
  15. Pollock BE, Schoeberl KA. Prospective comparison of posterior fossa exploration and stereotactic radiosurgery dorsal root entry zone target as primary surgery for patients with idiopathic trigeminal neuralgia. Neurosurgery. 2010; 67(3): 633–8; discussion 638.
  16. Urgosik D, Liscak R, Novotny J, et al. Treatment of essential trigeminal neuralgia with gamma knife surgery. J Neurosurg. 2005; 102 Suppl: 29–33.
  17. Hasegawa T, Kondziolka D, Spiro R, et al. Repeat Radiosurgery for Refractory Trigeminal Neuralgia. Neurosurgery. 2002; 50(3): 494–502.
  18. Park KJ, Kondziolka D, Berkowitz O, et al. Repeat gamma knife radiosurgery for trigeminal neuralgia. Neurosurgery. 2012; 70(2): 295–305; discussion 305.
  19. Brisman R, Khandji AG, Mooij RBM. Trigeminal Nerve-Blood Vessel Relationship as Revealed by High-resolution Magnetic Resonance Imaging and Its Effect on Pain Relief after Gamma Knife Radiosurgery for Trigeminal Neuralgia. Neurosurgery. 2002; 50(6): 1261–6, discussion 1266.
  20. Erbay SH, Bhadelia RA, Riesenburger R, et al. Association between neurovascular contact on MRI and response to gamma knife radiosurgery in trigeminal neuralgia. Neuroradiology. 2006; 48(1): 26–30.
  21. Jia Y, Pan Y, Ren H, et al. Effectiveness and Safety of High-Voltage Pulsed Radiofrequency to Treat Patients with Primary Trigeminal Neuralgia: A Multicenter, Randomized, Double-Blind, Controlled Study Protocol. Pain Physician. 2018; 21(5): 469–481.
  22. Taich ZJ, Goetsch SJ, Monaco E, et al. Stereotactic Radiosurgery Treatment of Trigeminal Neuralgia: Clinical Outcomes and Prognostic Factors. World Neurosurg. 2016; 90: 604–612.e11.
  23. Baschnagel AM, Cartier JL, Dreyer J, et al. Trigeminal neuralgia pain relief after gamma knife stereotactic radiosurgery. Clin Neurol Neurosurg. 2014; 117: 107–111.
  24. Ostrowski H, Roszak J, Komisarek O. Botulinum toxin type A as an alternative way to treat trigeminal neuralgia: a systematic review. Neurol Neurochir Pol. 2019; 53(5): 327–334.

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