CyberKnife Treatment of Medically Intractable Trigeminal Neuralgia: A Comparison of Isocentric and Non-isocentric Treatment Planning Outcomes.

BACKGROUND

Stereotactic radiosurgery (SRS) is commonly used to treat medically intractable trigeminal neuralgia. The target is either a point on the trigeminal nerve (isocentric treatment) or a finite length of the nerve (non-isocentric treatment). The superiority of one approach over the other is not well established. We compare our treatment outcomes for the two approaches in terms of pain relief and the most frequent side effect, facial numbness.

METHODOLOGY: A total of 83 consecutive patients (41 isocentric, 42 non-isocentric) were treated for trigeminal neuralgia with CyberKnife. Pain relief and facial numbness were scored using the Barrow Neurological Institute (BNI) scale, and the time to pain relief and facial numbness was recorded.

RESULTS

There was no statistically significant difference in the probability of pain relief or the time to pain relief or facial numbness. Symptomatic numbness (numbness score >= III) was more prevalent in patients treated with the non-isocentric technique (isocentric 4, 9.8%; non-isocentric 10, 23.8%; P = 0.048).

CONCLUSIONS

Isocentric and non-isocentric techniques provide equivalent pain relief for trigeminal neuralgia. Symptomatic facial numbness is more prevalent when using the non-isocentric technique.