Dosimetric Analysis of Brainstem Dose Constraints for Linac-Based Radiosurgery for Medical Management Refractory Trigeminal Neuralgia

Background and Objectives: The real impact of ionizing radiation on the heart and poorer overall survival for patients with non small cell lung cancer (NSCLC) remains unclear. This study aims to determine the safe dose constraints to the heart’s subregions that could prevent patients’ early non-cancerous death and improve their quality of life. Methods and Materials: A retrospective cohort study was performed containing 51 consecutive patients diagnosed with stage III NSCLC and treated using 3D, Intensity-modulated radiation therapy (IMRT), and Volumetric modulated arc therapy (VMAT) radiotherapy. For a dosimetric analysis, these structures were chosen: heart, heart base (HB), and region of great blood vessels (GBV). Dose–volume histograms (DVH) were recorded for all mentioned structures. Maximum and mean doses to the heart, HB, the muscle mass of the HB, and GBV were obtained. V10–V60 (%) parameters were calculated from the DVH. After performed statistical analysis, logistic regression models were created, and critical doses calculated. Results: The critical dose for developing a fatal endpoint for HB was 30.5 Gy, while for GBV, it was 46.3 Gy. Increasing the average dose to the HB or GBV by 1 Gy from the critical dose further increases the possibility of early death by 22.0% and 15.8%, respectively. Conclusions: We suggest that the non-canonical sub-regions of the heart (HB and GBV) should be considered during the planning stage. Additional constraints of the heart subregions should be chosen accordingly, and we propose that the mean doses to these regions be 30.5 Gy and 46.3 Gy, respectively, or less. Extrapolated DVH curves for both regions may be used during the planning stage with care.

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Experience with Conventional Radiofrequency Thermorhizotomy in Patients with Failed Medical Management for Trigeminal Neuralgia

The Korean Journal of Pain ◽

10.3344/kjp.2014.27.3.260 ◽

2014 ◽

Vol 27 (3) ◽

pp. 260 ◽

Cited By ~ 4

Author(s):

Sarita Singh ◽

Reetu Verma ◽

Manoj Kumar ◽

Virendra Rastogi ◽

Jaishree Bogra

Keyword(s):

Trigeminal Neuralgia ◽

Medical Management

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Dosimetric analysis of trigeminal nerve, brain stem doses in CyberKnife radiosurgery of trigeminal neuralgia

Journal of Medical Physics ◽

10.4103/0971-6203.99225 ◽

2012 ◽

Vol 37 (3) ◽

pp. 124 ◽

Cited By ~ 1

Author(s):

H Sudahar ◽

V Murali ◽

P. G. G. Kurup ◽

J Velmurugan

Keyword(s):

Trigeminal Neuralgia ◽

Brain Stem ◽

Trigeminal Nerve ◽

Cyberknife Radiosurgery ◽

Dosimetric Analysis

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Glossopharyngeal Neuralgia

Pain Neurosurgery ◽

10.1093/med/9780190887674.003.0004 ◽

2019 ◽

pp. 23-30

Author(s):

Oren Sagher

Keyword(s):

Weight Loss ◽

Trigeminal Neuralgia ◽

Microvascular Decompression ◽

Medical Management ◽

Treatment Modality ◽

Primary Treatment ◽

Glossopharyngeal Neuralgia ◽

Pain Condition ◽

Primary Treatment Modality ◽

Posterior Tongue

Glossopharyngeal neuralgia is an uncommon, but devastating pain condition. It shares many features with trigeminal neuralgia, but predominantly affects the posterior tongue and pharynx. Since glossopharyngeal neuralgia pain is frequently triggered by swallowing or movement of the tongue, patients frequently present with weight loss and dehydration. This chapter describes the classic features of this condition, including its association with syncope. The medical management of glossopharyngeal neuralgia is outlined as a primary treatment modality. Surgical considerations are also described, including microvascular decompression or sectioning of the glossopharyngeal nerve. Surgical pearls for both of these procedures are outlined, as well as strategies for complication avoidance and management.

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Correlation of Trigeminopontine Angle with Severity of Trigeminal Neuralgia due to Neurovascular conflict over medial aspect of nerve. Can we prognosticate the reduction in pain in patients on medical management?

10.21203/rs.3.rs-415743/v1 ◽

2021 ◽

Author(s):

Pundalik Umalappa Lamani ◽

Abhishek J Arora ◽

Kiran Kumar Reddy Kona ◽

Jyotsna Yarlagadda

Keyword(s):

Pain Relief ◽

Trigeminal Neuralgia ◽

Medical Management ◽

Rating Scale ◽

Treatment Plan ◽

Statistical Significance ◽

Poor Response ◽

Post Treatment ◽

Medial Aspect ◽

Neurovascular Conflict

Abstract Background: Neurovascular conflicts (NVC) are one of the major causative factors in patients presenting with Trigeminal neuralgia (TN). We found great degree of variation in acuteness of medial trigeminopontine angle (mTPA), angle between medial border of trigeminal nerve and anterior border of pons in patients with TN and tried to find its correlation with pain severity due to NVC over the medial aspect of nerve (mNVC).Aims and Objectives: To Correlate mTPA measurement with severity of trigeminal neuralgia due to mNVC. To calculate the reduction in pain in patients kept on medical management and its correlation with medial trigeminopontine angle.Material and Methods: This was a retrospective observational study conducted between May 2018 to October 2020. A total of 41 patients presenting with Trigeminal Neuralgia and showing corresponding Neurovascular conflict were included in the study. Out of the total cases with NVC, 30 cases showed NVC over the medial surface of the nerve. All the patients were evaluated on MAGNETOM Skyra 3T MRI (Siemens). Using Two-line Cobb angle method, trigeminopontine angle was calculated. Pre-treatment pain intensity and post treatment pain relief of each patients were assessed by using numeric rating scale (NRS). NRS with numbers from 0 to 10 (‘no pain’ to ‘worst pain imaginable’). Relevant clinical details regarding pre- and post-treatment pain score as well as treatment plan opted by patients were collected.Results: Patients with post treatment response ≥ 50% is considered as “good response” and < 50% is considered as “poor response”. In our study with trigeminopontine angle threshold of 45 degree, 7 out of 8 (87.5%) patients with > 450 mTPA showed poor response and 15/22 (68.2%) patients ≤ 450 showed good response to medical management for trigeminal neuralgia due to mNVC with statistical significance difference with p-valve of 0.007Conclusion: In our study, we found a negative correlation between the mTPA and percentage pain relief in patients kept on medical management. We realised that mTPA measurement could become an important tool for prognosticating pain relief for patients of trigeminal neuralgia on medical therapy.

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V2 Rhizotomy

Effective Techniques for Managing Trigeminal Neuralgia - Advances in Medical Diagnosis, Treatment, and Care ◽

10.4018/978-1-5225-5349-6.ch011 ◽

2018 ◽

pp. 216-242

Author(s):

Lucas W. Campos ◽

Nicholas Telischak ◽

Huy M. Do ◽

Xiang Qian

Keyword(s):

Trigeminal Neuralgia ◽

General Anesthesia ◽

Trigeminal Nerve ◽

Electric Shock ◽

Medical Management ◽

Facial Pain ◽

Interventional Procedures ◽

Pain Syndrome ◽

Ct Guided ◽

Flat Panel Ct

Trigeminal neuralgia is a facial pain syndrome characterized by excruciating, paroxysmal, electric shock-like pain attacks in the sensory distribution of the trigeminal nerve. Medical management remains the first line of treatment. When this fails, surgical management needs to be considered. Percutaneous interventional procedures such as glycerol rhizotomy, radiofrequency (RF) thermocoagulation, and balloon compression of the trigeminal ganglion and its branches are some of the most commonly used procedures as they avoid exposure to general anesthesia, provide successful short-term results, and are available to people with significant co-morbidities. Of these, RF is the most often used. The V2 and V3 branches of the trigeminal nerve are most commonly affected, and are thus the most frequent targets for RF interventions. These procedures may be performed using conventional fluoroscopic, ultrasound, or CT-guided imaging, including combined flat-panel CT and fluoroscopy. This chapter summarizes these common ablation techniques targeting the V2 branch of the trigeminal nerve.

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