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OBJECTIVE: How variations of treatment time affect the safety and efficacy of Gamma Knife (GK) radiosurgery is a matter of considerable debate. With the relative simplicity of treatment planning for trigeminal neuralgia (TN), this question has been addressed in a group of these patients. Using the concept of the biologically effective dose (BED), the effect of the two key variables, dose and treatment time, were considered. METHODS: A retrospective analysis was performed of 408 TN cases treated from 1997 to 2010. Treatment involved the use of a single 4 mm isocenter. If conditions allowed, the isocenter was placed at a median distance of 7.5 mm from the emergence of the trigeminal nerve from the brain stem. The effects were assessed in terms of the incidence of the complication, hypoesthesia, and in terms of efficacy using the incidence of pain free after 30 days and 1 and 2 years. These responses were evaluated with respect to both the physical dose and the BED, the latter using a biexponential repair model. RESULTS: RE-evaluation showed that the prescription doses, at the 100% isodose, varied from 75 to 97.9 Gy, delivered in 25-135 minutes. The relationship between the physical dose and the incidence of hypoesthesia was not significant; the overall incidence was similar to 20%. However, a clear relationship was found between the BED and the incidence of hypoesthesia, with the incidence increasing from
Georges Wagnières, Aurelien Stephen Arnaud Gregor
Christian Ludwig, Horst Pick, Stefanos Giannakis, Adrian Pulgarin, Jiahua Chen, Dominik Refardt, Jérémie Decker
Sylvain Dunand, Jonathan Emanuel Thomet, Luca Massimiliano Antognini, Matthew James Large