Stereotactic Radiosurgery for trigeminal neuralgia using Exactrac Dynamic. First experience
URIEL ALEXANDER CORRO VERDE,
Spain
PO-1130
Abstract
Stereotactic Radiosurgery for trigeminal neuralgia using Exactrac Dynamic. First experience
Authors: URIEL ALEXANDER CORRO VERDE1, Paola Andrea Navarrete Solano1, Rosa Fabregat Borras2, JOSE IGNACIO RABA DIEZ3, Veronica Cañón Garcia4, JOSE ANDRES VAZQUEZ RODRIGUEZ2, Javier Albendea Roch1, Marina Gutierrez2, Rodrigo Astudillo Olalla2, Ana Laura Rivero Perez5, Elisabet Arrojo Alvarez5, Frandeina Pinto Guevera5, Maria Teresa Pacheco Baldor2, Ivan Diaz De Cerio5, Pedro José Prada Gomez5
1Hospital Universitario Marques de Valdecilla, Oncología radioterápica, Santander, Spain; 2Hospital Universitario Marques de Valdecilla, Radiofisica, Santander, Spain; 3HOSPITAL UNIVERSITARIO MARQUES DE VALDECILLA, RADIOFISICA, Santander, Spain; 4Hospital Universitario Marques de Valdecill, Oncología radioterápica, Santander, Spain; 5Hospital Universitario Marques de Valdecilla, Oncología Radioterápica, Santander, Spain
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Purpose or Objective
The trigeminal neuralgia (TN) is a chronic, episodic, and disabling
facial pain syndrome. Has a prevalence
of 0.1-0.2 per thousand and an incidence ranging from about
4-5/100,000/year up to 20/100,000/year after age 60. The female-to-male ratio
is about 3:2. There is
a wide selection of studies concerning this issue, but only few of them
describe the radiosurgery SRS technique
in linear accelerator (LINAC). This study details our first experience treating TN in a Varian TrueBeam™ LINAC and
Perfect Pitch™ 6 DOF patient support couch. The positioning and monitoring was
performed with Brainlab Exactrac-Dynamic System®. We evaluated pain relief and
morbidity after TN SRS.
Material and Methods
Four patients were planned but only three were treated, all of them affected by
medically multirefractory TN. A single
isocenter of radiation focused on the intracisternal portion of the trigeminal
nerve 3mm anterior to the pons. The prescription dose was 90Gy with at least
70% isodose-line covering all thickness of the nerve. The isodose-line in
contact with pons was 26% less than 0,004cm3. Immobilization system with three
layers thermoplastic mask 4pi (Brainlabs®). Positioning with stereoscopic X-ray
after each couch movement. Intrafraction monitoring with X-Ray and thermal
camera with accuracy less than 0.3mm and 1mm respectively. The treatment plan
consist in arc-radiotherapy with 10 arcs ipsilateral to the affected nerve, all
with the same weight collimated with 4mm SRS-cone and coach movement every 10
grades.
Results
Median follow-up after radiosurgery
was 9 months (3-12 months). Pain relief was achieved for the three patients: one
after 2 weeks; other after 5 months and the last one after 1 week. The second
one got his pain cycle worse 3 weeks after SRS and required intrahospital treatment to pain control, only
one patient presents hypoesthesia on the face after 4.5months.
Conclusion
Stereotactic radiosurgery in a LINAC
is feasible technique and Exactrac-Dynamic System® can provide a safety
treatment delivery. SRS is a
well-established, efficient and safety option for the treatment of TN,
associated with a low risk of facial paresthesia and high probability of pain
relief.