Stereotactic radiosurgery using CT cisternography and non-isocentric planning for the treatment of trigeminal neuralgia

Figures & data

Table I.  Patient characteristics, pre-operative pain distribution, and prior treatments.

Male:Female		16:13
Age at time of treatment (years)	Median	67
	Min	42
	Max	92
Duration of symptoms (years)	Median	9
	Min	0.5
	Max	45
Side (L:R)		12:17
Pain Distribution	V1	0
	V2	9
	V3	7
	V1 V2	3
	V2 V3	8
	V1 V2 V3	1
	Tongue	1
Previous therapy	RF	2
	Glycerol	3
	RF + Gly	1
	Balloon	1
	MVD	6
	Nerve Stim	1
Pre-op numbness		7

Figure 1. Example of a treatment plan using the CyberKnife. [Color version available online]

Table II.  Description and results of TN patients treated with the CyberKnife.

Patient	Sex	Age	Side	Distribution	Duration of pain	Failed med	Previous treatment	Pre numbness	Fraction	Dmin	Dmax	Volume
1	M	79	R	V3	3	Yes	RF Rhiz	Yes	1	70	86.4	0.049
2	F	85	L	V2	30	Yes	None	No	1	66.4	81.94	0.101
3	M	83	R	V2	0.5	Yes	None	No	1	66	81.5	0.117
4	M	74	R	V1 V2	3	Yes	None	No	1	68	86.28	0.158
5	F	67	L	V2 V3	6	Yes	None	No	1	66	80.49	0.062
6	M	78	R	V2 V3	8	Yes	None	No	1	70	82.35	0.113
7	F	73	L	V2	10	Yes	RF rhiz	Yes: left V2	1	69	79.31	0.053
8	F	66	R	V2 V3	7	Yes	None	No	1	68	80	0.144
9	F	42	L	V2	10	Yes	None	No	1	60	73.17	0.033
10	F	46	R	V3	7	Yes	None	No	1	60	74.97	0.047
11	F	92	L	V2 V3	22	Yes	MVD & glycerol	No	1	64	73.56	0.051
12	F	54	L	V2	45	Yes	None	No	1	60	72.29	0.085
13	M	78	L	V1 V2	18	Yes	Glycerol × 2	Yes: left V1 V2	1	60	71.4	0.091
14	F	55	R	V2 V3	6	Yes	MVD	No	1	63	74.12	0.019
15	M	56	L	V2	10	Yes	MVD	No	1	66	82.51	0.056
16	M	49	R	V3 V2 V1	3	Yes	MVD	No	1	65.5	78	0.035
17	M	76	R	V2	4	Yes	None	No	1	65	78.31	0.04
18	M	78	R	V3	10	Yes	Glycerol	No	1	65	77.38	0.08
19	M	49	L	V3	10	Yes	RF & balloon	Yes: left V2 V3	1	66	82.5	0.03
20	F	78	R	V2 V3	15	Yes	None	No	1	70	79.55	0.044
21	F	72	R	V2 V3	0.5	Yes	None	No	1	68	77.27	0.029
22	F	48	R	V2	11	Yes	MVD	No	1	68	74.73	0.06
23	F	54	L	Tongue	25	Yes	None	No	1	68	77.27	0.03
24	M	58	R	V2	14	Yes	MVD & nerve stim	Yes: rt V1 V2 V3	1	62	72.94	0.037
25	M	49	R	V3	4,5	Yes	None	No	1	68	77.27	0.029
26	M	43	R	V3	5	Yes	None	No	1	68	77.27	0.08
27	M	82	R	V1 V2	7	Yes	None	No	1	67	77.91	0.036
28	M	58	L	V2 V3	10	Yes	MVD	Yes: left V2 V3	1	68	77.27	0.036
29	M	85	L	V3	8	Yes	Glycerol × 2	Yes: mild V3	1	70	85.37	0.056
	Mean	65.7586			11				Mean	66	78.4
	Min	42			0.5				Min	60	71.4
	Max	92			45				Max	70	86.4
	Med	67			9				Median	66.4	77.91
Patient	Follow-up (mo)	Initial relief	Time to relief	Post numbness	Time to recurrence (mo)	Time to numbness (mo)	A. dolorosa	Other	Medication status
1	24	Excellent	1 day	None	n/a	n/a	No		Off meds
2	22	Excellent	2 days	Mild L V1 V2	2	2	Yes		Resumed meds
3	20	Excellent	2 days	Mild R V2	n/a	6	No		Off meds
4	18	Excellent	1 day	Mild R V1 V2	na	4	No		Off meds
5	17	Excellent	4 days – 6 mos	Mild L V2 V3	n/a	6	No		Off meds
6	7	Excellent	4 days	Severe R V1-3	n/a	4	No
7	6	Excellent	3–5 wks	Mild L V2	6	6	No		Reduced meds
8	6	Excellent	4 wks – 2 mos	Mod V2 V3	n/a	3	No
9	15	None	n/a	None	n/a	n/a	No		Off meds
10	15	Excellent	2–3 mos	Mod R V3	n/a	3	No	Trismus	Off meds
11	14	Excellent	2 wks – 1 mo	Left V2 V3	n/a	2	No		Off meds
12	12	Excellent	n/a	Severe L V1-3	n/a	5	Yes	L masticator & corneals	Resumed meds
13	14	Excellent	1 month	Mild L V1 V2	n/a	4	No		Off meds
14	12	Excellent	8 wks – 3 mos	Mild R V2 V3	n/a	9	No		Off meds
15	10	Moderate	8 wks	Mild L V2	n/a	8	No	Diplopia, CR	Same dose
16	12	Excellent	7 days	Severe R V1-3	n/a	6	No		Off meds
17	10	Excellent	6 days	Mild R V2	n/a	8	No		Off meds
18	10	Excellent	7 days	Mild R V3	n/a	3	No		Off meds
19	9	Excellent	3 mos	Left V2 V3	8	1	No		Resumed at same dose
20	7	Excellent	2 days	Mod V1-3	n/a	5	No	Drooling, decreased CR	Reduced meds
21	5	Excellent	1 day	Mod V2 V3	n/a	3	No		Off meds
22	5	Excellent	2 days – 1 mo	None	n/a	n/a	No		Off meds
23	4	Excellent	1 month	None	n/a	n/a	No		Off meds
24	5	Excellent	2 wks – 1 mo	No new	n/a	n/a	No		Same
25	4	No change	No change	Mild R V3	n/a	1	No	Spinal leak	Resumed meds
26	3	Excellent for 2 mo	4–7 days	None	1	n/a	No		Was completely off for 2 mos
27	3	Excellent	2–10 days	None	n/a	n/a	No		Off meds
28	2	Excellent	3–10 days	None	n/a	n/a	No		Reduced meds
29	6	Excellent	1–2 mos	None	n/a	n/a	No		Off meds
	10.2		Median = 6.5 days	None 8
	2			Mild 12		Median = 4
	24			Mod 4		Mean = 4.6
	10			Severe 3

Figure 2. Example of a treatment plan where the Gasserian ganglion was inadvertently included in the target volume. [Color version available online]