Download PDF
CC BY 4.0 · Indian Journal of Neurosurgery
DOI: 10.1055/s-0044-1801829
Original Article

Efficacy of CyberKnife Stereotactic Radiosurgery in Treating Trigeminal Neuralgia: A Single-Institution Study

Nihanthy D. Sreenath 
1   Saroj Gupta Cancer Centre and Research Institute, Kolkata, India
,
Mahadev Potharaju
2   Department of Radiation Oncology, Apollo Cancer Institute, Chennai, Tamil Nadu, India
,
Sanjay Chandrasekar
2   Department of Radiation Oncology, Apollo Cancer Institute, Chennai, Tamil Nadu, India
,
Balamurugan Mangaleswaran
3   Department of Neurosurgery, Apollo Cancer Institute, Chennai, Tamil Nadu, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Introduction Trigeminal neuralgia (TN) is a chronic facial pain disorder. While medications like analgesics and antiepileptics are first-line treatments, some patients may require surgical options like microvascular decompression or rhizotomies, which carry neurological risks. CyberKnife frameless stereotactic radiosurgery (CK SRS) offers a noninvasive, effective alternative with fewer side effects.

Methods and Materials In our study, 30 patients with unilateral TN (VAS [visual analog scale] score > 5) were treated. Using computed tomography and magnetic resonance imaging, a 5 to 6 mm segment of the trigeminal nerve, located 2 to 3 mm distal to the brainstem's dorsal root entry zone, was targeted. A 60 Gy dose, prescribed to a median isodose of 85%, was delivered for radiosurgical rhizotomy.

Results Patients were followed for a median of 48 months. Of the 30 patients, 21 achieved satisfactory pain relief (VAS ≤ 3), with pain relief occurring at varying intervals, and 9 patients had partial relief (VAS > 3) and remained on medication. One patient had a recurrence pain and was re-irradiated at 36 months. Ten patients developed facial numbness, assessed using the Barrow Neurological Institute Facial Numbness Scale score, with a latency period of 10 months. All patients were on carbamazepine, gabapentin, and mecobalamin until pain relief was achieved.

Conclusion The nearly 70% success rate after SRS is comparable to or better than other treatment modalities for TN. Nonisocentric CyberKnife SRS proves to be a safe and effective option for managing TN.

Keywords

trigeminal neuralgia - CyberKnife - nonisocentric - radiosurgery - rhizotomy

Supplementary Material



Publication History

Article published online:
02 April 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia 2004; 24 (1, Suppl 1): 9-160
    CrossrefPubMedSearch in Google Scholar
  • 2 De Simone R, Marano E, Brescia Morra V. et al. A clinical comparison of trigeminal neuralgic pain in patients with and without underlying multiple sclerosis. Neurol Sci 2005; 26 (Suppl. 02) s150-s151
    PubMedSearch in Google Scholar
  • 3 Cheshire WP. Trigeminal neuralgia feigns the terrorist. Cephalalgia 2003; 23 (03) 230
    PubMedSearch in Google Scholar
  • 4 De Toledo IP, Conti Réus J, Fernandes M. et al. Prevalence of trigeminal neuralgia: a systematic review. J Am Dent Assoc 2016; 147 (07) 570-576.e2
    PubMedSearch in Google Scholar
  • 5 Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013; 33 (09) 629-808
    CrossrefPubMedSearch in Google Scholar
  • 6 Thomas KL, Vilensky JA. The anatomy of vascular compression in trigeminal neuralgia. Clin Anat 2014; 27 (01) 89-93
    CrossrefPubMedSearch in Google Scholar
  • 7 Heinskou TB, Rochat P, Maarbjerg S. et al. Prognostic factors for outcome of microvascular decompression in trigeminal neuralgia: a prospective systematic study using independent assessors. Cephalalgia 2019; 39 (02) 197-208
    PubMedSearch in Google Scholar
  • 8 Maarbjerg S, Wolfram F, Gozalov A, Olesen J, Bendtsen L. Significance of neurovascular contact in classical trigeminal neuralgia. Brain 2015; 138 (Pt 2): 311-319
    CrossrefPubMedSearch in Google Scholar
  • 9 Cohen AS, Matharu MS, Goadsby PJ. Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) or cranial autonomic features (SUNA)–a prospective clinical study of SUNCT and SUNA. Brain 2006; 129 (Pt 10): 2746-2760
    PubMedSearch in Google Scholar
  • 10 Zakrzewska JM, Linskey ME. Trigeminal neuralgia. BMJ Clin Evid 2014; 2014: x
    PubMedSearch in Google Scholar
  • 11 Gronseth G, Cruccu G, Alksne J. et al. Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the European Federation of Neurological Societies. Neurology 2008; 71 (15) 1183-1190
    PubMedSearch in Google Scholar
  • 12 Cruccu G, Gronseth G, Alksne J. et al; American Academy of Neurology Society, European Federation of Neurological Society. AAN-EFNS guidelines on trigeminal neuralgia management. Eur J Neurol 2008; 15 (10) 1013-1028
    CrossrefPubMedSearch in Google Scholar
  • 13 Obermann M. Recent advances in understanding/managing trigeminal neuralgia. F1000 Res 2019;8:F1000 Faculty Rev-505
    PubMed
  • 14 Sandell T, Eide PK. Effect of microvascular decompression in trigeminal neuralgia patients with or without constant pain. Neurosurgery 2008; 63 (01) 93-99 , discussion 99–100
    PubMedSearch in Google Scholar
  • 15 Hagenacker T, Bude V, Naegel S. et al. Patient-conducted anodal transcranial direct current stimulation of the motor cortex alleviates pain in trigeminal neuralgia. J Headache Pain 2014; 15 (01) 78
    PubMedSearch in Google Scholar
  • 16 Kustermans L, Van Buyten J-P, Smet I, Coucke W, Politis C. Stimulation of the Gasserian ganglion in the treatment of refractory trigeminal neuropathy. J Craniomaxillofac Surg 2017; 45 (01) 39-46
    PubMedSearch in Google Scholar
  • 17 Jakobs M, Unterberg A, Treede R-D, Schuh-Hofer S, Ahmadi R. Subcutaneous trigeminal nerve field stimulation for refractory trigeminal pain: a cohort analysis. Acta Neurochir (Wien) 2016; 158 (09) 1767-1774
    PubMedSearch in Google Scholar
  • 18 Klein J, Sandi-Gahun S, Schackert G, Juratli TA. Peripheral nerve field stimulation for trigeminal neuralgia, trigeminal neuropathic pain, and persistent idiopathic facial pain. Cephalalgia 2016; 36 (05) 445-453
    PubMedSearch in Google Scholar
  • 19 Leksell L. Sterotaxic radiosurgery in trigeminal neuralgia. Acta Chir Scand 1971; 137 (04) 311-314
    PubMedSearch in Google Scholar
  • 20 Sheehan J, Pan H-C, Stroila M, Steiner L. Gamma knife surgery for trigeminal neuralgia: outcomes and prognostic factors. J Neurosurg 2005; 102 (03) 434-441
    PubMedSearch in Google Scholar
  • 21 Adler Jr JR, Bower R, Gupta G. et al. Nonisocentric radiosurgical rhizotomy for trigeminal neuralgia. Neurosurgery 2009; 64 (2, Suppl): A84-A90
    PubMedSearch in Google Scholar
  • 22 A Study of Amifostine for Prevention of Facial Numbness in Radiosurgery Treatment of Trigeminal Neuralgia - Study Results - ClinicalTrials.gov [Internet]. [cited 2020 Nov 28]. Accessed December 20, 2024 at: https://clinicaltrials.gov/ct2/show/results/NCT01364259
    PubMed
  • 23 Kondziolka D, Lacomis D, Niranjan A. et al. Histological effects of trigeminal nerve radiosurgery in a primate model: implications for trigeminal neuralgia radiosurgery. Neurosurgery 2000; 46 (04) 971-976 , discussion 976–977
    PubMedSearch in Google Scholar
  • 24 Régis J, Metellus P, Dufour H. et al. Long-term outcome after gamma knife surgery for secondary trigeminal neuralgia. J Neurosurg 2001; 95 (02) 199-205
    PubMedSearch in Google Scholar
  • 25 Flickinger JC, Pollock BE, Kondziolka D. et al. Does increased nerve length within the treatment volume improve trigeminal neuralgia radiosurgery? A prospective double-blind, randomized study. Int J Radiat Oncol Biol Phys 2001; 51 (02) 449-454
    CrossrefPubMedSearch in Google Scholar
  • 26 Villavicencio AT, Lim M, Burneikiene S. et al. Cyberknife radiosurgery for trigeminal neuralgia treatment: a preliminary multicenter experience. Neurosurgery 2008; 62 (03) 647-655 , discussion 647–655
    CrossrefPubMedSearch in Google Scholar
  • 27 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 (02) 359-364
    PubMedSearch in Google Scholar
  • 28 Dhople AA, Adams JR, Maggio WW, Naqvi SA, Regine WF, Kwok Y. Long-term outcomes of Gamma Knife radiosurgery for classic trigeminal neuralgia: implications of treatment and critical review of the literature. Clinical article. J Neurosurg 2009; 111 (02) 351-358
    CrossrefPubMedSearch in Google Scholar
  • 29 Riesenburger RI, Hwang SW, Schirmer CM. et al. Outcomes following single-treatment Gamma Knife surgery for trigeminal neuralgia with a minimum 3-year follow-up. J Neurosurg 2010; 112 (04) 766-771
    PubMedSearch in Google Scholar
  • 30 Kondziolka D, Zorro O, Lobato-Polo J. et al. Gamma Knife stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 2010; 112 (04) 758-765
    PubMedSearch in Google Scholar
  • 31 Di Carlo DT, Benedetto N, Perrini P. Clinical outcome after microvascular decompression for trigeminal neuralgia: a systematic review and meta-analysis. Neurosurg Rev 2022; 46 (01) 8
    PubMedSearch in Google Scholar
  • 32 Patil CG, Veeravagu A, Bower RS. et al. CyberKnife radiosurgical rhizotomy for the treatment of atypical trigeminal nerve pain. Neurosurg Focus 2007; 23 (06) E9
    PubMedSearch in Google Scholar
  • 33 Sudahar H, Kurup PGG, Murali V, Velmurugan J. Comparative analysis between 5 mm and 7.5 mm collimators in CyberKnife radiosurgery for trigeminal neuralgia. J Med Phys 2013; 38 (03) 120-124
    PubMedSearch in Google Scholar