A dosimetric comparison between Gamma Knife and CyberKnife treatment plans for trigeminal neuralgia.

Martina Descovich, Penny K. Sneed, Nicholas Barbaro, Michael W. McDermott, Cynthia F. Chuang, Igor J. Barani, Jean L. Nakamura, M. Lijun

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

The Leksell Gamma Knife and the Accuray CyberKnife systems have been used in the radio surgical treatment of trigeminal neuralgia. The 2 techniques use different delivery methods and different treatment parameters. In the past, CyberKnife treatments have been associated with an increased incidence of treatment-related complications, such as facial numbness. The goal of this study was to develop a method for planning a CyberKnife treatment for trigeminal neuralgia that would reproduce the dosimetric characteristics of a Gamma Knife plan. A comparison between Gamma Knife and CyberKnife treatment plans obtained with this method is presented. Five patients treated using the Gamma Knife Perfexion Unit were selected for this study. All patients underwent CT cisternography to accurately identify the position of the trigeminal nerve. The Gamma Knife plans used either one 4-mm-diameter collimator or two coincident 4-mm collimators (one open and one with sector blocking) placed at identical isocenter coordinates. A maximum local dose of 80 Gy was prescribed. Critical structures and representative isodose lines were outlined in GammaPlan and exported to the CyberKnife treatment planning platform. CyberKnife treatments were developed using the 5-mm-diameter cone and the trigeminal node set, which provides an effective collimation diameter of 4 mm at the isocenter. The 60-Gy isodose volume imported from GammaPlan was used as the target in the CyberKnife plans. The CyberKnife treatments were optimized to achieve target dose and critical structure sparing similar to the Gamma Knife plans. Isocentric and nonisocentric delivery techniques were investigated. Treatment plans were compared in terms of dosimetric characteristics, delivery, and planning efficiency. CyberKnife treatments using the 5-mm cone and the trigeminal node set can closely reproduce the dose distribution of Gamma Knife plans. CyberKnife isocentric and nonisocentric plans provide comparable results. The average length of the trigeminal nerve receiving a dose of 60 Gy was 4.5, 4.5, and 4.4 mm for Gamma Knife, nonisocentric CyberKnife, and isocentric CyberKnife, respectively. However, minimizing the dose to the critical structures was more difficult with the CyberKnife and required the use of tuning structures. In addition, the dose fall off away from the target was steeper in Gamma Knife plans, probably due to the larger number of beams (192 beams for perfexion vs ~ 100 beams for cyberknife). While the treatment time with the cyberknife is generally shorter, the planning time is significantly longer. CyberKnife radiosurgical parameters can be optimized to mimic the dose distribution of Gamma Knife plans. However, Gamma Knife plans result in superior sparing of critical structures (brainstem, temporal lobe,and cranial nerves VII and VIII) and in steeper dose fall off away from the target. The clinical significance of these effects is unknown. (DOI: 10.3171/2010.8.GKS101002)

Original languageEnglish (US)
Pages (from-to)199-206
Number of pages8
JournalJournal of Neurosurgery
Volume113 Suppl
DOIs
StatePublished - Dec 2010
Externally publishedYes

Fingerprint

Trigeminal Neuralgia
Therapeutics
Trigeminal Nerve
Vestibulocochlear Nerve
Hypesthesia
Facial Nerve
Temporal Lobe
Radio
Brain Stem

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Descovich, M., Sneed, P. K., Barbaro, N., McDermott, M. W., Chuang, C. F., Barani, I. J., ... Lijun, M. (2010). A dosimetric comparison between Gamma Knife and CyberKnife treatment plans for trigeminal neuralgia. Journal of Neurosurgery, 113 Suppl, 199-206. https://doi.org/10.3171/2009.12.JNS091936

A dosimetric comparison between Gamma Knife and CyberKnife treatment plans for trigeminal neuralgia. / Descovich, Martina; Sneed, Penny K.; Barbaro, Nicholas; McDermott, Michael W.; Chuang, Cynthia F.; Barani, Igor J.; Nakamura, Jean L.; Lijun, M.

In: Journal of Neurosurgery, Vol. 113 Suppl, 12.2010, p. 199-206.

Research output: Contribution to journalArticle

Descovich, M, Sneed, PK, Barbaro, N, McDermott, MW, Chuang, CF, Barani, IJ, Nakamura, JL & Lijun, M 2010, 'A dosimetric comparison between Gamma Knife and CyberKnife treatment plans for trigeminal neuralgia.', Journal of Neurosurgery, vol. 113 Suppl, pp. 199-206. https://doi.org/10.3171/2009.12.JNS091936
Descovich, Martina ; Sneed, Penny K. ; Barbaro, Nicholas ; McDermott, Michael W. ; Chuang, Cynthia F. ; Barani, Igor J. ; Nakamura, Jean L. ; Lijun, M. / A dosimetric comparison between Gamma Knife and CyberKnife treatment plans for trigeminal neuralgia. In: Journal of Neurosurgery. 2010 ; Vol. 113 Suppl. pp. 199-206.
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N2 - The Leksell Gamma Knife and the Accuray CyberKnife systems have been used in the radio surgical treatment of trigeminal neuralgia. The 2 techniques use different delivery methods and different treatment parameters. In the past, CyberKnife treatments have been associated with an increased incidence of treatment-related complications, such as facial numbness. The goal of this study was to develop a method for planning a CyberKnife treatment for trigeminal neuralgia that would reproduce the dosimetric characteristics of a Gamma Knife plan. A comparison between Gamma Knife and CyberKnife treatment plans obtained with this method is presented. Five patients treated using the Gamma Knife Perfexion Unit were selected for this study. All patients underwent CT cisternography to accurately identify the position of the trigeminal nerve. The Gamma Knife plans used either one 4-mm-diameter collimator or two coincident 4-mm collimators (one open and one with sector blocking) placed at identical isocenter coordinates. A maximum local dose of 80 Gy was prescribed. Critical structures and representative isodose lines were outlined in GammaPlan and exported to the CyberKnife treatment planning platform. CyberKnife treatments were developed using the 5-mm-diameter cone and the trigeminal node set, which provides an effective collimation diameter of 4 mm at the isocenter. The 60-Gy isodose volume imported from GammaPlan was used as the target in the CyberKnife plans. The CyberKnife treatments were optimized to achieve target dose and critical structure sparing similar to the Gamma Knife plans. Isocentric and nonisocentric delivery techniques were investigated. Treatment plans were compared in terms of dosimetric characteristics, delivery, and planning efficiency. CyberKnife treatments using the 5-mm cone and the trigeminal node set can closely reproduce the dose distribution of Gamma Knife plans. CyberKnife isocentric and nonisocentric plans provide comparable results. The average length of the trigeminal nerve receiving a dose of 60 Gy was 4.5, 4.5, and 4.4 mm for Gamma Knife, nonisocentric CyberKnife, and isocentric CyberKnife, respectively. However, minimizing the dose to the critical structures was more difficult with the CyberKnife and required the use of tuning structures. In addition, the dose fall off away from the target was steeper in Gamma Knife plans, probably due to the larger number of beams (192 beams for perfexion vs ~ 100 beams for cyberknife). While the treatment time with the cyberknife is generally shorter, the planning time is significantly longer. CyberKnife radiosurgical parameters can be optimized to mimic the dose distribution of Gamma Knife plans. However, Gamma Knife plans result in superior sparing of critical structures (brainstem, temporal lobe,and cranial nerves VII and VIII) and in steeper dose fall off away from the target. The clinical significance of these effects is unknown. (DOI: 10.3171/2010.8.GKS101002)

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