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CyberKnife Radiosurgery Stops Facial Pain

February 2, 2012
Written by: , Filed in: Neuroradiology
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The CyberKnife radiosurgery system can noninvasively relieve a type of facial nerve pain called trigeminal neuralgia, according to a small study published online last week in the Journal of NeuroInterventional Surgery.

The CyberKnife normally targets tumors. It uses real-time imaging and a robotic arm to deliver precisely targeted, highly concentrated beams of radiation.

In this study, the researchers aimed at the trigeminal nerve, a three-branched nerve that carries sensations from the face to the brain. Trigeminal neuralgia, which causes electric shock–like facial pain and spasms, affects up to five in 100,000 people. The condition generally strikes in middle age. Pain episodes are usually brief, but they can be so severe that they can trigger depression.

Standard treatments include drugs and surgery. Radiation therapy has been tried, according to the study authors, but it has left up to half of patients with facial numbness.

A team of radiologists, radiation oncologists, and a neurosurgeon at Winthrop-University Hospital in Mineola, New York (on Long Island), tried the CyberKnife on 17 patients whose trigeminal neuralgia hadn’t responded to medication or previous surgery. The doctors used the beam to irradiate a 6-millimeter section of the trigeminal nerve.

Follow-up data were available for 16 of the patients. Of those, 14 experienced either partial or complete pain relief. Eleven reported freedom from all pain at some point following the surgery, and seven of those remained pain-free through their last follow-up visit, which took place an average of five months after surgery.

More research on larger patient cohorts is obviously needed. But, the study concludes:

Non-isocentric radiosurgery can be used as an alternative to more invasive treatments and warrants further follow-up and investigation.

Neuralgia symptoms did recur in four patients, at about three, eight, nine, and 18 months after surgery. Only two patients reported side effects: a “feathery dysesthesia” (pain resulting from a normal stimulus) and a mild loss of sensation in the surgical area.

Related seminar: Neuro & Musculoskeletal Imaging

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