{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T18:50:19Z","timestamp":1792176619334,"version":"4.4.0"},"reference-count":31,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n<jats:title>Background: <\/jats:title>\n<jats:p>Frameless image-guided radiosurgery (IGRS) is an effective and non-invasive method of treating patients who are unresponsive to medical management for trigeminal neuralgia (TN). This study evaluated the use of frameless IGRS to treat patients with medically refractory TN.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st2\">\n<jats:title>Methods: <\/jats:title>\n<jats:p>We performed a retrospective review of records of 116 patients diagnosed with TN who underwent frameless IGRS using a linear accelerator (LINAC) over 10 years (March 2012-February 2023). All patients had failed medical management for TN. Facial pain was graded using the Barrow Neurological Institute (BNI) scoring system. Each patient received a BNI score before frameless IGRS and following treatment. Failure was defined as a BNI score IV-V at the last follow-up and\/or undergoing a salvage procedure following IGRS.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st3\">\n<jats:title>Results: <\/jats:title>\n<jats:p>All patients had a BNI score of either IV or V before the frameless IGRS. The mean follow-up duration for all 116 patients following IGRS was 44.1 months. Most patients (81 [69.8%]) had not undergone surgery (microvascular decompression [MVD] or rhizotomy) or stereotactic radiosurgery (SRS) for TN before frameless IGRS. A total of 41 (35.3%) patients underwent a salvage procedure (MVD, rhizotomy, or an additional IGRS) following frameless IGRS. The mean duration between the initial frameless IGRS and salvage procedure was 20.1 months. At the last follow-up, a total of 110 (94.8%) patients had a BNI score of I-III. No complications were reported after the frameless IGRS. The BNI score at the last follow-up was lower compared to the initial BNI for patients regardless of prior intervention (<jats:italic>P<\/jats:italic> &lt; 0.001). Patients who failed IGRS had a higher BNI score at the last follow-up compared to those who did not fail IGRS (2.8 vs. 2.5, <jats:italic>P<\/jats:italic> = 0.05). Patients with pain relief had a shorter follow-up compared to those with pain refractory to SRS (38.0 vs. 55.1, <jats:italic>P<\/jats:italic> = 0.005).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st4\">\n<jats:title>Conclusion: <\/jats:title>\n<jats:p>In this large cohort of patients with medically refractory TN, frameless IGRS resulted in durable pain control in the majority of patients without any toxicity.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_101_2024","type":"journal-article","created":{"date-parts":[[2024,5,31]],"date-time":"2024-05-31T09:54:46Z","timestamp":1717149286000},"page":"181","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Frameless image-guided linear accelerator (LINAC) stereotactic radiosurgery for medically refractory trigeminal neuralgia: Clinical outcomes in 116 patients"],"prefix":"10.25259","volume":"15","author":[{"given":"Lisa B. E.","family":"Shields","sequence":"first","affiliation":[{"name":"Norton Healthcare, Norton Neuroscience Institute, Louisville, Kentucky, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azzam","family":"Malkawi","sequence":"additional","affiliation":[{"name":"Norton Neuroscience Institute, Norton Healthcare, Norton Cancer Institute, Louisville, Kentucky, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael W.","family":"Daniels","sequence":"additional","affiliation":[{"name":"Department of Bioinformatics and Biostatistics, University of Louisville, School of Public Health and Information Sciences, Louisville, Kentucky, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abigail J.","family":"Rao","sequence":"additional","affiliation":[{"name":"Norton Healthcare, Norton Neuroscience Institute, Louisville, Kentucky, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian M.","family":"Plato","sequence":"additional","affiliation":[{"name":"Norton Healthcare, Norton Neuroscience Institute, Louisville, Kentucky, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom L.","family":"Yao","sequence":"additional","affiliation":[{"name":"Norton Healthcare, Norton Neuroscience Institute, Louisville, Kentucky, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan N.","family":"Howe","sequence":"additional","affiliation":[{"name":"Norton Neuroscience Institute, Norton Healthcare, Norton Cancer Institute, Louisville, Kentucky, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron C.","family":"Spalding","sequence":"additional","affiliation":[{"name":"Norton Neuroscience Institute, Norton Healthcare, Norton Cancer Institute, Louisville, Kentucky, United 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