• IRSA. Stereotactic radiosurgery for patients with intractable typical trigeminal neuralgia who have failed medical management. Harrisburg (PA): IRSA; 2003 Sep. 10 p. (Radiosurgery practice guideline report; no. 1-03). [43 references]

This is the current release of the guideline.

• Stereotactic radiosurgery is defined as a relatively high dose of focused radiation delivered precisely to the trigeminal root nerve, under the direct supervision of a medical team (neurosurgeon, radiation oncologist, registered nurse, and medical physicist), in one surgical session.
• Patients with typical trigeminal neuralgia who have had an adequate trial of medications can be offered stereotactic radiosurgery. Stereotactic radiosurgery is typically used in patients with medical co-morbidities or pain refractory to prior surgical procedures, patients at risk for side effects from percutaneous ablative procedures, and those in more advanced age groups.
• The optimal dose range for trigeminal neuralgia has been established. A commonly used dose range of 75 to 90 Gy in a single fraction to the trigeminal nerve is suggested, using a 4-mm collimator radiation field. Most centers prefer 80 Gy as a central dose targeted to the trigeminal nerve a few millimeters proximal to its entry into the brain stem; however, 90 Gy as a central dose to the trigeminal nerve near the trigeminal ganglion has also been used routinely in some centers.
• Patients who have failed other surgical procedures for trigeminal neuralgia should also receive 75 to 90 Gy to the trigeminal nerve. A safe interval between the initial surgery and stereotactic radiosurgery is unknown, but it is reasonable to perform radiosurgery if there is no improvement or pain recurs following the initial surgical procedures.
• After radiosurgery, patients are followed to assess pain relief at three-month, six-month and yearly intervals. Their pre-radiosurgery pain medications are continued at the same doses until pain relief is obtained. Medications can be gradually tapered off if the patient remains pain free.
• Patients who have recurrence of pain following trigeminal neuralgia radiosurgery or who had a partial initial response can undergo a second stereotactic radiosurgery using 50 to 70 Gy to the trigerminal nerve (depending on the elapsed time between treatments). A generally safe interval between first and second radiosurgeries is six months.
• At present, technology to deliver focal small-volume fields is limited to Gamma Knife® by the strength of published data. Early data from dedicated modified linear accelerator centers with documented ability to deliver beams <5 mm are under evaluation.

The original guideline contains a clinical algorithm for "Trigeminal Neuralgia Management."

Type I, II, and III evidence exists in support of stereotactic radiosurgery for intractable trigeminal neuralgia. Refer to the "Rating Scheme for the Strength of the Evidence" field.

• IRSA. Stereotactic radiosurgery for patients with intractable typical trigeminal neuralgia who have failed medical management. Harrisburg (PA): IRSA; 2003 Sep. 10 p. (Radiosurgery practice guideline report; no. 1-03). [43 references]

Not applicable: The guideline was not adapted from another source.

2003 Sep

IRSA - Professional Association

IRSA is a non-profit entity dedicated to promoting the development of scientifically relevant practice guidelines for stereotactic radiosurgery. IRSA works to educate and provide support for physicians, hospitals, insurers, and patients.

IRSA

IRSA Physician Advisory Board Guidelines Committee

Committee members: Dr. L. Dade Lunsford, MD, Neurosurgeon (Chair); Ajay Niranjan, MBBS, MCh, Neurosurgeon; Ron Young, MD, Neurosurgeon; Ronald Brisman, MD, Neurosurgeon; David Cunningham, MD, Neurosurgeon; Christer Lindquist, MD, Neurosurgeon (European Co-Chair); David Newell, MD, Neurosurgeon; John C. Flickinger, MD, Radiation Oncologist; Ann Maitz, MS, Medical Physicist; Tonya K. Ledbetter, MS, MFS, Editor; Rebecca L. Emerick, MS, MBA, CPA, ex officio

Not stated

This is the current release of the guideline.

None available

This NGC summary was completed by ECRI on March 8, 2004. The information was verified by the guideline developer on April 7, 2004.

This guideline is copyrighted by IRSA and may not be reproduced without the written permission of IRSA. IRSA reserves the right to revoke copyright authorization at any time without reason.