Frameless stereotactic radiosurgery treatments are proving effective in relieving intense facial pain associated with trigeminal neuralgia, according to a study published online in the Journal of NeuroInterventional Surgery, part of the British Medical Journal (BMJ) Group.
Patients with trigeminal neuralgia, also known as tic douloureux, experience a constant sharp, stabbing pain or burning sensation affecting the jaw or cheek. While brief, these episodes are recurrent and debilitating. The pain historically has been treated with surgery or anticonvulsant and antidepressant medications. The condition affects four to five people out of every 100,000.
Physicians at Winthrop-University Hospital in Mineola, New York, reported on the outcomes of 17 consecutive patients who underwent stereotactic radiosurgery (CyberKnife, Accuray) between May 2007 and July 2009. The patients, who were between ages 36 and 90, had had their symptoms for one to 11 years and had not responded to the available treatment options (JNIS, 25 January 2012).
All patients underwent CT cisternography, a radiographic study of the basal cisterns of the brain using a low-osmolar iodine contrast medium, for treatment planning. The target segment was consistently defined as a 6-mm-length of nerve approximately 2-3 mm distal to the dorsal root entry zone of the brainstem.
The patients underwent a radiosurgical rhizotomy using a single 5- or 7.5-mm collimator to deliver an average maximum radiation dose of 73.06 Gy. The mean target volume was 73.02 mm, with a range of 39.74 to 145.74 mm, according to radiology department chairman Dr. Orlando Ortiz and a co-author of the study.
Fourteen of the patients obtained either partial or complete relief from their symptoms. On average, this occurred within two months following treatment. Four patients experienced a relapse in symptoms three to 18 months following treatment. Only two patients reported sensory side effects in their jaws, and none of the patients had substantial complications relating to the stereotactic radiosurgery.
Acknowledging that the patients were followed for only a short time period, from one to 27 months, with a median of a year, and that their number was very small, the authors recommended that future studies of nonisocentric radiosurgery be performed. They specifically recommended that studies comparing the CyberKnife, the Gamma Knife Elekta, and surgical treatment be performed.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
