Trigeminal neuralgia due to microvascular conflict – upfront radiosurgery
SKULL BASE REGION
Trigeminal cistern
HISTOPATHOLOGY
N/A
PRIOR SURGICAL RESECTION
N/A
PERTINENT LABORATORY FINDINGS
N/A
Case description
The patient is an 82-year-old woman who suffered from tic douloureux in the left V2 and V3 territory. Her pain was initially well controlled on carbamazepine, but progressively became highly resistant to polytherapy. Brain magnetic resonance imaging (MRI) demonstrated a major neurovascular conflict between the cisternal portion of the trigeminal nerve and a dolichoectatic basilar artery. Stereotactic radiosurgery (SRS) was recommended ( Figure 9.42.1 ), and the patient agreed to proceed with treatment.
Radiosurgery Machine
Gamma Knife – Icon
Radiosurgery Dose (Gy)
90 at the 100% isodose point
Number of Fractions
1
Critical Structure
Dose Tolerance
Brainstem
< 0.01 cc > 15 Gy
Basilar artery
Very tolerant
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