{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T15:56:54Z","timestamp":1792079814777,"version":"4.4.0"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2017,12,23]],"date-time":"2017-12-23T00:00:00Z","timestamp":1513987200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/ mailto:journals.permissions@oup.com"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["NEUROSURGERY","NEUROS"],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Frameless, non-isocentric irradiation of an extended segment of the trigeminal nerve introduces new concepts in stereotactic radiosurgery for medically resistant trigeminal neuralgia (TN).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To report the results of the largest single-center experience about image-guided robotic radiosurgery for TN.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A cohort of 138 patients treated with CyberKnife\u00ae (Accuray Incorporated, Sunnyvale, California) radiosurgery with a minimum follow-up of 36 mo were recruited. Pain relief, medications, sensory disturbances, rate and time of pain recurrence were prospectively analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Median follow-up was 52.4 mo; median dose 75 Gy; median target length 5.7-mm; median target volume 40 mm\u00b3; median prescription dose 60 Gy (80% isodose line). Actuarial pain control rate (Barrow Neurological Institute [BNI] class I-IIIa) at 6, 12, 24, and 36 mo were 93.5%, 85.8%, 79.7%, and 76%, respectively. Overall, 33 patients (24%) required a second treatment.<\/jats:p>\n                    <jats:p>\n                      Overall, 18.1% developed sensory disturbances after 16.4\u00a0\u00b1\u00a08.7 mo. One patient (0.7%) developed BNI grade IV dysfunction; 6 (4.3%) developed BNI grade III (somewhat bothersome) hypoesthesia after retreatment; BNI grade II (not bothersome) hypoesthesia was reported by 18 patients (11 after retreatment). Shorter nerve length (&lt;6 mm vs 6 mm), smaller nerve volume (&lt;30 mm\n                      <jats:sup>3<\/jats:sup>\n                      vs &gt;30 mm\n                      <jats:sup>3<\/jats:sup>\n                      ), and lower prescription dose (&lt;58 vs &gt;58 Gy) were associated with treatment failure (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.01,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.02,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.03, respectively). Re-irradiation independently predicted sensory disturbance (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0&lt;\u00a0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Targeting a 6-mm segment of the trigeminal nerve with a prescribed dose of 60 Gy appears safe and effective. Persistent pain control was achieved in most patients with acceptable risk of sensory complications, which were typically found after re-irradiation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/neuros\/nyx571","type":"journal-article","created":{"date-parts":[[2017,12,6]],"date-time":"2017-12-06T23:11:40Z","timestamp":1512601900000},"page":"1023-1030","source":"Crossref","is-referenced-by-count":30,"title":["Image-Guided Robotic Radiosurgery for Trigeminal Neuralgia"],"prefix":"10.1227","volume":"83","author":[{"given":"Pantaleo","family":"Romanelli","sequence":"first","affiliation":[{"name":"Centro Diagnostico Italiano, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfredo","family":"Conti","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Messina, Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Livia","family":"Bianchi","sequence":"additional","affiliation":[{"name":"Centro Diagnostico Italiano, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Achille","family":"Bergantin","sequence":"additional","affiliation":[{"name":"Centro Diagnostico Italiano, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Martinotti","sequence":"additional","affiliation":[{"name":"Centro Diagnostico Italiano, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giancarlo","family":"Beltramo","sequence":"additional","affiliation":[{"name":"Centro Diagnostico Italiano, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,11]]},"reference":[{"issue":"7586","key":"bib1-20231011","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1136\/bmj.39085.614792.BE","article-title":"Trigeminal neuralgia and its management","volume":"334","author":"Bennetto","year":"2007","journal-title":"BMJ"},{"issue":"2","key":"bib2-20231011","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1177\/1756285609359317","article-title":"Treatment options in trigeminal neuralgia","volume":"3","author":"Obermann","year":"2010","journal-title":"Ther Adv Neurol Disord"},{"issue":"1","key":"bib3-20231011","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3171\/jns.1999.90.1.0001","article-title":"Microvascular decompression of cranial nerves: lessons learned after 4400 operations","volume":"90","author":"Mclaughlin","year":"1999","journal-title":"J Neurosurg"},{"issue":"7079","key":"bib4-20231011","first-page":"520","article-title":"Treatment for trigeminal neuralgia. 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