Treatment of Right-Sided V1 and V2 Distribution Trigeminal Neuralgia
Patient History
An 87-year-old female presented with a 20-year history of right-sided V1 and V2 Trigeminal Neuralgia which had in the past been partially controlled on Dilantin. However, in the last 1 1⁄2 years prior to presentation, she had severe frequent daily attacks that were unresponsive to escalating doses of Dilantin. Of note, the patient had developed Tegretol toxicity many years prior, and this had prompted the change from Tegretol to Dilantin. Various options open to the patient were discussed with her, including microvascular decompression, glycerol injection, radiofrequency rhizotomy, balloon compression, as well as radiosurgical treatment. An MRI of the brain showed no vascular loops, enhancing soft tissue masses, or other focal lesions in association with the right-sided trigeminal root entry zone.
CyberKnife Advantage
The patient's age made the CyberKnife a particularly attractive alternative to the other options for the relief of her tic pain.
Treatment
The patient was treated on the frameless CyberKnife System at Newport Diagnostic Center with a single fraction to a total dose of 80 Gy centered at the root entry zone.
Outcome & Follow-Up
The patient's Trigeminal Neuralgia attacks ceased the day after the radiosurgical treatment. She was pain-free for approximately 1 1⁄2 weeks. At one month, she reported having experienced occasional, very mild forms of right-sided Trigeminal Neuralgia, but in comparison with her pre-radiosurgical treatment pain, the tic douloureux pain was negligible.The patient tapered her medication and ceased taking any 5 months following treatment. In follow-up examinations at 3, 6 and 12 months after treatment, she reported complete resolution of her pain. At 12 months, she reported a mild degree of medial periorbital subjective sense of numbness. Otherwise she has had no other neurological symptoms.
Location
CyberKnife at Newport Diagnostic Center, Newport Beach, CA USA
