Article

Linear accelerator thalamotomy.

Division of Neurosurgery, School of Medicine, University of California-Los Angeles Medical Center, 200 UCLA Medical Plaza, Los Angeles, CA 90095-7182, USA.
Surgical Neurology (impact factor: 1.67). 09/2004; 62(2):106-13; discussion 113-4. DOI:10.1016/j.surneu.2003.08.033 pp.106-13; discussion 113-4
Source: PubMed

ABSTRACT The capability of performing functional radiosurgery lesions in the brain using a dedicated linear accelerator (LINAC) have not yet been demonstrated. This study evaluates modern LINAC technology for the creation of a sharp, small and functionally eloquent lesion in the thalamus.
Three patients underwent thalamotomy using a dedicated linear accelerator to radiosurgery, 2 females and 1 male, ages were 52, 53, and 73 years. Two patients presented with unilateral poststroke central pain and 1 with unilateral upper extremity pain secondary to metastatic infiltration of the brachial plexus. Maximal doses varied from 150 to 200 Gy, delivered by a 5-mm diameter collimator and 5 to 8 noncoplanar arcs evenly distributed.
All patients gained substantial relief of their pain. They were able to reduce their medications and improve their activity levels. The patient with end-stage metastatic disease died of his malignancy 2 weeks after the treatment. One patient presented with recurrence of the pain 4 months after the treatment. No clinical complications were noticed.
A dedicated linear accelerator is able to perform a precise and circumscribed lesion in the thalamus for pain control. Moreover, it proved to be safe, because no complications were observed. For patients using chronic anticoagulant therapy or with severe disabilities caused by cardiac, pulmonary or malignant diseases, this technique represents an alternative of treatment to radiofrequency thalamotomy.

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Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

1 male
 
2 females
 
8 noncoplanar arcs
 
activity levels
 
chronic anticoagulant therapy
 
circumscribed lesion
 
clinical complications
 
dedicated linear accelerator
 
end-stage metastatic disease
 
functional radiosurgery lesions
 
functionally eloquent lesion
 
malignancy 2 weeks
 
malignant diseases
 
Maximal doses varied
 
metastatic infiltration
 
modern LINAC technology
 
pain 4 months
 
severe disabilities
 
unilateral poststroke central pain
 
unilateral upper extremity pain secondary