Stereotactic radiosurgery using CyberKnife for trigeminal neuralgia

Abstract

CyberKnife, an image-guided robotic radiosurgery, introduces advances in stereotactic radiosurgery for medically resistant trigeminal neuralgia. The frameless CyberKnife radiosurgery (CKR) can deliver either non-isocentric irradiation to an extended segment of the trigeminal nerve or isocentric irradiation to a pinpoint portion of trigeminal nerve. These characteristics of CKR are vastly different from the Gamma Knife radiosurgery (GKS). However, the differences between CKR and GKS regarding the ratio of pain relief to the number of treatments required to achieve it and the frequency of complications, such as hypoesthesia of the trigeminal nerve, were not significant. Radiosurgery does not have the concomitant risks of an open surgery; therefore, CKR should be evaluated as a minimally invasive technique for the management of recurrent trigeminal neuralgia with the goal of reducing nerve injury at the root entry zone or the retrogasserian region.