Frameless stereotactic radiosurgery for the treatment of multiple sclerosis-related trigeminal neuralgia.

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Frameless stereotactic radiosurgery for the treatment of multiple sclerosis-related trigeminal neuralgia.

World Neurosurg. 2017 Apr 25;:

Authors: Conti A, Pontoriero A, Iatì G, Esposito F, Siniscalchi EN, Crimi S, Vinci S, Brogna A, Ponte F, Germanò A, Pergolizzi S, Tomasello F

Abstract
BACKGROUND: Trigeminal neuralgia (TN) affects 7% of patients with multiple sclerosis (MS). In such patients, TN is difficult to manage either pharmacologically and surgically. Radiosurgical rhizotomy is an effective treatment option. The non-isocentric geometry of radiation beams of CyberKnife introduces new concepts in the treatment of TN. Its efficacy for MS-related TN has not yet been demonstrated.
METHODS: Twenty-seven patients with refractory TN and MS were treated. A non-isocentric beams distribution was chosen; the maximal target dose was 72.5 Gy. The maximal dose to the brainstem was <12 Gy. Effects on pain, medications, sensory disturbance, rate and time of pain recurrence were analyzed.
RESULTS: Median follow-up was 37 (18-72) months. Barrow Neurological Institute (BNI) pain scale score I-III was achieved in 23/27 (85%) patients within 45 days. Prescription isodose line (80%) accounting for a dose of 58 Gy incorporated an average of 4.85 mm (4-6 mm) of the nerve and mean nerve volume of 26.4 mm(3) (range 20-38 mm(3)). Seven out of 27 (26%) patients had mild, not bothersome facial numbness (BNI numbness score II). The rate of pain control decreased progressively after the first year and only 44% of patient retained pain control 4 years later.
CONCLUSIONS: Frameless radiosurgery can be effectively used to perform retrogasserian rhizotomy. Pain relief was satisfactory and, with our dose/volume constraints, no sensory complications were recorded. Nonetheless, long-term pain control was possible in less than half of the patients. This is a limitation that Cyberknife radiosurgery shares with other techniques in MS patients.

PMID: 28454993 [PubMed - as supplied by publisher]

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