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IGRT surgery enables trigeminal neuralogia patient to go pain-free after 20 years

Varian : 12 July, 2007  (New Product)
Eleanor Taylor is living pain free thanks to a medical team at the University of California, San Diego (UCSD) Medical Center who performed image-guided radiosurgery using Varian Medical Systems’ Trilogy technology.
After years of suffering pain 'like shooting electric shocks' down the left side of her face, Taylor, now 83, suffered the first of many attacks immediately after a routine tooth extraction in 1992, and she was subsequently diagnosed with trigeminal neuralgia, an intractable disorder of the trigeminal nerve.

'Trigeminal neuralgia is a very incapacitating pain disorder,' said Kevin Murphy, MD, chief of the stereotactic Radiosurgery programme in the Department of Radiation Oncology at UCSD Medical Center. 'By the time she came to us for evaluation, Taylor was at the end of her rope. She had tried many different treatments, including drug therapies, Radiosurgery with cobalt sources, and, most recently, balloon compression of the left trigeminal nerve. She gained relief for a period of months, but her severe pain always returned.'

In February of this year, Taylor's neurosurgeon John Alksne, MD, asked Murphy to evaluate her for possible treatment on the Trilogy machine, a powerful medical linear accelerator that delivers precisely targeted and finely shaped beams of radiation to destroy tumours or other abnormalities. Alksne's hope was to eradicate or at least ameliorate Taylor's unbearable pain once and for all.

'The trigeminal nerve is responsible for sensation in the jaw and face, so you don't want to destroy it, but you have to calm it down and stop it from firing randomly,' explained Alksne, who is a professor of neurosurgery at UCSD.

Trilogy treatments are a painless, noninvasive, and typically performed on an outpatient basis in less than an hour.

Using Computed tomography (CT) and magnetic resonance (MR) images of the area to be treated, Murphy worked with his clinical team to design a treatment plan for Taylor that would focus the Radiosurgery beams on her trigeminal nerve while protecting her eyes, optic nerves, and brainstem.

The Trilogy machine is outfitted with two imaging systems that make it possible to deliver radiation with great precision: the On-Board Imager device for generating 3-D images of the targeted area prior to treatment, and the FramelessArray optical guidance system, which uses an optical camera to continuously monitor the patient's position during treatment.

'Eleanor had been through a cobalt radiosurgical procedure, which requires immobilisation with a fixation device that is screwed into the skull, and she did not want to repeat that experience,' Alksne explained. 'She was very pleased when we told her that treatment on Varian's Trilogy machine would not require this kind of bolted headframe immobilisation. With the Trilogy machine, the image guidance tools help us to ensure that treatment beams are delivered accurately.'

To perform the radiosurgery, Murphy and Alksne used a tiny beam five millimetres in diameter. The procedure was complete after just 40 minutes.

'We anticipated that it would take anywhere from two weeks to two months for us to know how much benefit Eleanor was going to realise from the treatment,' Alksne said.

By the end of two months, Eleanor's pain had completely disappeared, and the result has been durable.

'I'm doing fine,' she said in a recent phone interview. 'I've been driving into the city and I'm glad to have that freedom back because I'm a very independent person. I haven't had any more pain.'

Taylor was introduced to Dr Alksne through a trigeminal neuralgia support group in San Diego that provided her with information about the condition and its treatment.

'I want people to know about this disease, and to know about support groups, because they are a life saver. I worry about people who have this kind of pain and don't know where to go. They need to find a support group and a neurosurgeon like Dr Alksne. He has done everything possible to help me,' she said.
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