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  • Author or Editor: Antonio A. F. De Salles x
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Leonardo Frighetto, Antonio A. F. De Salles, Eric Behnke, Zachary A. Smith and Dennis Chute

✓ Interactive image-guided neuronavigation was used to obtain biopsy specimens of cavernous sinus (CS) tumors via the foramen ovale. In this study the authors demonstrated a minimally invasive approach in the management of these lesions.

In four patients, whose ages ranged from 29 to 89 years (mean 61.2 years) and who harbored undefined lesions invading the CS, neuronavigation was used to perform frameless stereotactic fine-needle biopsy sampling through the foramen ovale. The biopsy site was confirmed on postoperative computerized tomography scanning.

The frameless technique was accurate in displaying a real-time trajectory of the biopsy needle throughout the procedure. The lesions within the CS were approached precisely and safely. Diagnostic tissue was obtained in all cases and treatment was administered with the aid of stereotactic radiosurgery or fractionated stereotactic radiotherapy. The patients were discharged after an overnight stay with no complications.

Neuronavigation is a precise and useful tool for image-guided biopsy sampling of CS tumors via the foramen ovale.

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Zachary A. Smith, Antonio A. F. De Salles, Leonardo Frighetto, Bryan Goss, Steve P. Lee, Michael Selch, Robert E. Wallace, Cynthia Cabatan-Awang and Timothy Solberg

Object. In this study the authors evaluate the efficacy of and complications associated with dedicated linear accelerator (LINAC) radiosurgery for trigeminal neuralgia (TN).

Methods. Between August 1995 and February 2001, 60 patients whose median age was 66.1 years (range 45–88 years) were treated with dedicated LINAC radiosurgery for TN. Forty-one patients (68.3%) had essential TN, 12 (20%) had secondary facial pain, and seven (11.7%) had atypical features. Twenty-nine patients (48.3%) had undergone previous surgical procedures. Radiation doses varied between 70 and 90 Gy (mean 83.3 Gy) at the isocenter, with the last 35 patients (58.3%) treated with a 90-Gy dose. A 5-mm collimator was used in 45 patients (75%) and a 7.5-mm collimator in 15 patients (25%). Treatment was focused at the nerve root entry zone.

At last follow up (mean follow-up period 23 months, range 2–70 months), 36 (87.8%) of the 41 patients with essential TN had sustained significant pain relief (good plus excellent results). Twenty-three patients (56.1%) were pain free without medication (excellent outcome), 13 (31.7%) had a 50 to 90% reduction in pain with or without medication (good outcome), and five (12.2%) had minor improvement or no relief. Of 12 patients with secondary facial pain, significant relief was sustained in seven patients (58.3%); worse results were found with atypical pain. Fifteen (25%) of the 60 patients experienced new numbness postprocedure; no other significant complications were found. Pain relief was experienced at a mean of 2.7 months (range 0–12 months).

Conclusions. Dedicated LINAC radiosurgery is a precise and effective treatment for TN.