Trigeminal Rhizotomy Using Gyroscopic Radiosurgery: A Case Report

Characterized by intense, episodic lancinating pain within the distribution of the trigeminal nerve, trigeminal neuralgia (TN) is the most common craniofacial pain syndrome. Failure of medical management requires the consideration of interventional procedures. Stereotactic radiosurgery (SRS) is one...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2022-05, Vol.14 (5), p.e24951
Main Authors: Klassen, Peter D, Ivaturi, Sai K, Hendricks, Benjamin K
Format: Article
Language:English
Subjects:
Case reports
Magnetic resonance imaging
Multiple sclerosis
Narcotics
Neurosurgery
Pain Management
Planning
Radiation Oncology
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Summary:Characterized by intense, episodic lancinating pain within the distribution of the trigeminal nerve, trigeminal neuralgia (TN) is the most common craniofacial pain syndrome. Failure of medical management requires the consideration of interventional procedures. Stereotactic radiosurgery (SRS) is one of the more commonly used surgical options. Herein, we report the first published case of a patient with TN treated in the ZAP-X (San Carlos, CA: ZAP Surgical Systems, Inc.) gyroscopic radiosurgery system. This 59-year-old man with multiple sclerosis and recurrent intractable left idiopathic TN following previous SRS was retreated in the Zap-X system using 100 isocentric 5 mm beams to a dose of 7500 cGy. At a three-month follow-up, the patient reported a 45% decrease in his visual analogue scale (VAS) and a reduced need for medication. Albeit preliminary, this initial experience highlights the feasibility of a self-shielded, cobalt-free, device for radiosurgically treating TN.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.24951