Radiosurgery – Is it the right choice?

Radiosurgery is an outpatient treatment that focuses hundreds of very small beams of radiation on an intracranial lesion.  It has revolutionized the treatment of small brain tumors (including metastatic tumors, meningiomas, schwannomas, and others) as well as brain blood vessel malformations.  It has also been used for some time to treat trigeminal neuralgia.

If you are considering radio surgery, make sure that you are dealing with a very experienced radiosurgery team.  The trigeminal nerve target is very small, so absolute accuracy is required and this is not available on every commercial radiosurgery system.  I would recommend systems that use a head ring and have a proven mechanical accuracy of less than .5mm.

I have used radiosurgery to treat over 4500 patients since we first started in 1988.  We have extensively published our results (over 150 papers and chapters) and spoken at over a 100 international and national meetings.  I was president of the International Stereotactic Radiosurgery Society.  And yet I am not very enthusiastic about radiosurgery for trigeminal neuralgia.  Why?

  1.  It takes 6-8 weeks for radiosurgery to produce pain relief.  Many of my patients can’t wait that long.
  2. Many patients still need to take medication after radiosurgery to control their pain. Why is that a problem.  Well, side effects of medical treatment are what bring most patients to surgical treatment.  If you have to continue meds, disabling side effects may also continue.
  3. Radiosurgery has a poorer long term pain control record than microvascular decompression.  That is, your pain relief is more likely to be temporary than with other surgical approaches.

That said, the advantage of radiosurgery is that it virtually eliminates the rare but occasionally very serious risks of open surgery.  If radiosurgery fails, it will not preclude you from pursuing other options.

So, think about it!