A Guide to Stereotactic Radiosurgery for Trigeminal Neuralgia

Trigeminal neuralgia is a chronic pain condition, often caused by a blood vessel of the brain impinging on the trigeminal nerve. One treatment option available in northern NJ is stereotactic radiosurgery.

Making Sense of Your Options

Diagnosing and treating trigeminal neuralgia used to be very difficult. Thankfully, doctors now understand that your facial pain is likely caused by a blood vessel impinging on the trigeminal nerve. This results in aberrant pain signals from your face. One treatment option available in the tri-state area is stereotactic radiosurgery. Whether you are still in the treatment planning process or already have your procedure scheduled, understanding more about stereotactic radiosurgery for trigeminal neuralgia can help you as you move forward on the path to recovery.

Understanding Stereotactic Radiosurgery

Stereotactic radiosurgery is an advanced form of radiation therapy to treat a highly focused area. By contrast, traditional radiation therapy doses a larger area over many sessions. This can damage healthy tissues, leading to unpleasant side effects like hair loss and nausea.

Stereotactic radiosurgery was developed in Sweden over 40 years ago to treat brain tumors. There are now a variety of delivery systems, including Gamma Knife radiosurgery and CyberKnife. Most of the information following pertains to stereotactic radiosurgery as a whole. However, differences in the Gamma Knife radiosurgery and CyberKnife procedures are highlighted further on.

Choosing Stereotactic Radiosurgery for Trigeminal Neuralgia

As your doctor works with you to develop your treatment plan, there are many factors to take into consideration. These include your personal health factors, like age and complicating health conditions. Other trigeminal neuralgia treatment options include medications to manage symptoms or surgery. Some reasons your doctor may recommend stereotactic radiosurgery for trigeminal neuralgia include:

  • Medications were not effective for you, or they have lost effectiveness over time
  • Side effects from medications are too unpleasant
  • You are not a good surgical candidate due to health complications
  • You have undergone trigeminal neuralgia treatment, but your symptoms have returned (refractory trigeminal neuralgia)
  • You prefer a minimally invasive treatment option

Risks & Benefits of Stereotactic Radiosurgery for Trigeminal Neuralgia

The primary benefit of stereotactic radiosurgery for trigeminal neuralgia is relief from pain. In fact, most patients experience some degree of pain relief in approximately 8 weeks. The degree of symptom resolution you experience will be a very individual process. However, one study found that 95% of patients had at least some degree of relief approximately one year following treatment, and 40% had complete pain resolution.

Stereotactic radiosurgery for trigeminal neuralgia also has benefits when compared to surgery. These include:

  • No hospital stay
  • No incisions, sutures or scars
  • No risk of reaction to general anesthesia
  • No risk of infection or bleeding at a surgical site
  • Reduced pain and overall healing time – most patients are back to normal activities within a day or two

As with any medical procedure, there are risks when undergoing stereotactic radiosurgery for trigeminal neuralgia. These include headaches, nausea, fatigue and hydrocephalus, discussed in more detail below. Another risk is facial numbness, which occurs in approximately 5-10% of cases.

The Stereotactic Radiosurgery Treatment Process

Stereotactic radiosurgery takes place in an outpatient setting. This means you do not have to stay overnight in the hospital. Before your procedure, you may undergo diagnostic imaging, such as an MRI or CT scan. You will not be asleep during your procedure, so you will be able to eat and drink during the time before.

What happens during your procedure will depend on which system your doctor uses. Two options available in northern NJ are Gamma Knife radiosurgery and CyberKnife. Both have the same treatment goals, but the treatment processes are fairly different.

During Your Treatment

During Gamma Knife radiosurgery, you will either wear a lightweight headframe or custom-fit mask. This will help stabilize your head during the procedure. The system uses infrared cameras to detect any movement, which does not involve any extra radiation. Your doctor will use a high-resolution MRI to evaluate the treatment site and finalize your treatment plan.

Once the procedure begins, the table you are on moves, maintaining the focus of treatment on the same site throughout. There are 192 tiny beams of low-dose radiation all treating the area, which combine to have a therapeutic effect. This treatment typically lasts 15-75 minutes. Once complete, the headframe or mask is removed and you are able to return home within an hour or two.

The CyberKnife system utilizes a face mask and a single beam of radiation energy, which is mounted on a mobile robotic arm. The arm moves around your body, treating different areas with the single beam. The CyberKnife system uses a series of x-rays to detect changes in position. Treatment typically takes 30-90 minutes, after which you are released to return home.

After Your Treatment

Following stereotactic radiosurgery, you will likely feel fatigued for a day or two. You may also experience headaches or nausea. Your doctor may prescribe medications to help you manage any unpleasant side effects. However, these are typically mild and transient.

It will be important that you attend all follow-up visits scheduled with your doctor. During these appointments, your doctor will assess your pain resolution and check for any side effects following treatment. Without these appointments, your doctor will not be able to assess your healing or catch any side effects at the early stages.

Continue the Discussion

Now you have a deeper understanding of stereotactic radiosurgery for trigeminal neuralgia. Be sure to continue the discussion with your personal doctor. He or she will be able to relate the information here to your individual case and answer any lingering questions you may have. Self-education is an excellent way to be comfortable with your upcoming treatment, and speaking more with your doctor is a great next step.

Anthony D’Ambrosio, M.D., M.B.A., F.A.A.N.S
Anthony D’Ambrosio, M.D., M.B.A., F.A.A.N.S
Dr. Anthony D’Ambrosio is a board-certified neurosurgeon that specializes in Neurosurgery, Stereotactic Radiosurgery, Gamma Knife Radiosurgery (GKRS) and more. He is the Director of Neurosurgery and Co-Director of the Gamma Knife Program at The Valley Hospital. Dr. D’Ambrosio is an expert in treating patients with trigeminal neuralgia, benign or malignant brain tumors, as well as many other neurological conditions.

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