Trigeminal neuralgia: Treatment with the Cyberknife

INTRODUCTION: Radiosurgery has played an increasing role in the treatment of trigeminal neuralgia. We present our experience at Stanford University in treating patients with the Cyberknife. METHODS: 83 patients were treated between May 2002 and June 2006 for idiopathic trigeminal neuralgia at Stanford University (Stanford, California). Patients were followed for the pain control, side effects, and time to pain recurrence with respect to the length of the nerve treated, Dmax, and Dmin. RESULTS: 79 patients (95%) experienced initial pain relief after treatment. Patients reported excellent pain relief in 71 patients (85.6%), moderate pain relief in 6 patients (7.2%), and mild pain relief in 2 patients (2.2%). At a mean of 19 months follow up, recurrence of pain occurred in only 6 patients (7.6%) of the patients. Numbness occurred in 73.5% of the patients, but the majority ranked the numbness as mild or moderate. A statistically significant correlation to the Dmin and length of nerve treated to numbness was observed. CONCLUSION: Cyberknife radiosurgery offers an efficacious form or treatment for trigeminal neuralgia. At 19 months follow up, the response also appears to be durable.