Kerolus Mena G, Sen Neilayan, Mayekar Sonal, Templeton Alistar, Turian Julius, Diaz Aidnag, Munoz Lorenzo, Byrne Richard W, Sani Sepehr
Neurosurgery, Rush University Medical Center.
Radiation Oncology, Rush University Medical Center.
Cureus. 2017 Jun 16;9(6):e1362. doi: 10.7759/cureus.1362.
Radiosurgery is now an established method of satisfactory pain control in patients with trigeminal neuralgia (TN). The Varian Truebeam STx (Varian Medical Systems, Palo Alto, CA) linear accelerator (LINAC) system is an arc-based, frameless stereotactic radiosurgery system used for the treatment of TN. To our knowledge, there has been only one published series of patient histories that documents the use of a frameless LINAC system for the treatment of TN. We describe the treatment parameters, patient outcomes, and complications associated with the treatment of TN.
All patients treated with the Truebeam system for TN between 2012 and 2015, with at least a six-month follow-up, were identified. A dose of 90 Gy was delivered to the isocenter using a 0.5 cm diameter cone. The cisternal segment of the trigeminal nerve was placed at the location of the LINAC isocenter using an ExacTrac™ (Brainlab, Munich, Germany) image guidance system. The radiosurgical dose, Barrow Neurologic Institute pain score (BNI PS), symptom recurrence, magnetic resonance imaging (MRI) radiographic changes, and other complications, including Barrow Neurologic Institute facial numbness score (BNI FN), were analyzed.
A total of 18 patients-15 women and 3 men-with a mean age of 58 years (median: 59 years; range: 22-84 years) were treated at our institution. Fourteen patients (78%) had a BNI PS of IIIb or better, which was considered successful treatment. Twelve patients had excellent (BNI PS I) pain relief and two patients had good (BNI PS II-IIIB; recurrence after one year) pain relief. The pain of four patients recurred after a mean of 10 months.
Truebeam radiosurgery can provide effective and safe treatment for patients suffering from TN. The efficacy appears similar to other frame- and frameless-based systems.
放射外科手术现已成为治疗三叉神经痛（TN）患者疼痛的一种成熟方法。瓦里安Truebeam STx（瓦里安医疗系统公司，加利福尼亚州帕洛阿尔托）直线加速器（LINAC）系统是一种基于弧形的无框架立体定向放射外科系统，用于治疗TN。据我们所知，仅有一篇已发表的系列患者病史记录了使用无框架LINAC系统治疗TN的情况。我们描述了与TN治疗相关的治疗参数、患者预后及并发症。
确定2012年至2015年间使用Truebeam系统治疗TN且至少随访6个月的所有患者。使用直径0.5厘米的准直器向等中心给予90 Gy的剂量。使用ExacTrac™（德国慕尼黑Brainlab公司）图像引导系统将三叉神经的脑池段置于LINAC等中心位置。分析放射外科剂量、巴罗神经学研究所疼痛评分（BNI PS）、症状复发、磁共振成像（MRI）影像学变化以及其他并发症，包括巴罗神经学研究所面部麻木评分（BNI FN）。
我们机构共治疗了18例患者，其中15例女性，3例男性，平均年龄58岁（中位数：59岁；范围：22 - 84岁）。14例患者（78%）的BNI PS为IIIb或更好，这被认为是成功治疗。12例患者疼痛得到极佳缓解（BNI PS I），2例患者疼痛得到良好缓解（BNI PS II - IIIB；1年后复发）。4例患者的疼痛在平均10个月后复发。
Truebeam放射外科手术可为TN患者提供有效且安全的治疗。其疗效似乎与其他基于框架和无框架的系统相似。
