{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T22:31:24Z","timestamp":1789165884077,"version":"build-2803163510"},"reference-count":27,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"Special_Suppl","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2012,12]]},"abstract":"\nObject<\/jats:title>\nDose-volume data concerning the brainstem in stereotactic radiosurgery (SRS) for trigeminal neuralgia (TN) were analyzed in relation to associated complications. The authors present their set of data and compare it with currently cited information on brainstem dose tolerance associated with conventional fractionated radiation therapy and hypofractionated radiation treatment of other diseases.<\/jats:p><\/jats:sec>\n\nMethods<\/jats:title>\nStereotactic radiosurgery for TN delivers a much higher radiation dose to the brainstem in a single fraction than doses delivered by any other procedures. A literature survey of articles on radiosurgery for TN revealed no incidences of severe toxicity, unlike other high-dose procedures involving the brainstem. Published data on brainstem dose tolerance were investigated and compared with dose-volume data in TN radiosurgery. The authors also performed a biological modeling study of dose-volume data involving the brainstem in cases of TN treated with the Gamma Knife, CyberKnife, and linear accelerator\u2013based systems.<\/jats:p><\/jats:sec>\n\nResults<\/jats:title>\nThe brainstem may receive a maximum dose as high as 45 Gy during radiosurgery for TN. The major complication after TN radiosurgery is mild to moderate facial numbness, and few other severe toxic responses to radiation are observed. The biologically effective dose of 45 Gy in a single fraction is much higher than any brainstem dose tolerance currently cited in conventional fractionation or in single or hypofractionated radiation treatments. However, in TN radiosurgery, the dose falloff is so steep and the delivery so accurate that brainstem volumes of 0.1\u20130.5 cm3<\/jats:sup> or larger receive lower planned and delivered doses than those in other radiation-related procedures. Current models are suggestive, but an extensive analysis of detailed dose-volume clinical data is needed.<\/jats:p><\/jats:sec>\n\nConclusions<\/jats:title>\nPatients whose TN is treated with radiosurgery are a valuable population in which to demonstrate the dose-volume effects of an extreme hypofractionated radiation treatment on the brainstem. The result of TN radiosurgery suggests that a very small volume of the brainstem can tolerate a drastically high dose without suffering a severe clinical injury. The authors believe that the steep dose gradient in TN radiosurgery plays a key role in the low toxicity experienced by the brainstem.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2012.7.gks12962","type":"journal-article","created":{"date-parts":[[2018,11,16]],"date-time":"2018-11-16T00:55:40Z","timestamp":1542329740000},"page":"189-196","source":"Crossref","is-referenced-by-count":31,"title":["Dose-volume effects on brainstem dose tolerance in radiosurgery"],"prefix":"10.3171","volume":"117","author":[{"given":"Jinyu","family":"Xue","sequence":"first","affiliation":[{"name":"Departments of Radiation Oncology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. Warren","family":"Goldman","sequence":"additional","affiliation":[{"name":"Neurological Surgery, Cooper University Hospital, Camden, New Jersey;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jimm","family":"Grimm","sequence":"additional","affiliation":[{"name":"Holy Redeemer Hospital, Meadowbrook, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamara","family":"LaCouture","sequence":"additional","affiliation":[{"name":"Departments of Radiation Oncology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Chen","sequence":"additional","affiliation":[{"name":"Departments of Radiation Oncology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lesley","family":"Hughes","sequence":"additional","affiliation":[{"name":"Departments of Radiation Oncology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen","family":"Yorke","sequence":"additional","affiliation":[{"name":"Department of Medical Physics, Memorial Sloan\u2013Kettering Cancer Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-1170189","series-title":"Med Phys","first-page":"4078","article-title":"Stereotactic body radiation therapy: the report of AAPM Task Group 101","volume":"37","author":"Benedict","year":"2010"},{"key":"b2-1170189","series-title":"Int J Radiat Oncol Biol Phys","first-page":"205","article-title":"Dose-volume effects in the rat cervical spinal cord after proton irradiation","volume":"52","author":"Bijl","year":"2002"},{"key":"b3-1170189","series-title":"Am J Clin Oncol","first-page":"637","article-title":"Stereotactic body radiation therapy: a comprehensive review","volume":"30","author":"Chang","year":"2007"},{"key":"b4-1170189","series-title":"Int J Radiat Oncol Biol Phys","first-page":"213","article-title":"Tolerance of the spinal cord to stereotactic radiosurgery: insights from hemangioblastomas","volume":"80","author":"Daly","year":"2011"},{"key":"b5-1170189","series-title":"Int J Otolaryngol","article-title":"Clinical outcomes of gamma knife radiosurgery in the treatment of patients with trigeminal neuralgia","author":"Elaimy","year":"[epub ahead of print]"},{"key":"b6-1170189","series-title":"Int J Radiat Oncol Biol Phys","first-page":"449","article-title":"Does increased nerve length within the treatment volume improve trigeminal neuralgia radiosurgery? 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