Face the Pain: Radiobiological and Clinical Considerations of Re-radiosurgery to the Trigeminal Nerve Following Irradiation of an Abutting Petroclival Meningioma

TL;DR

This paper discusses a case where a patient with persistent trigeminal neuralgia after radiation for a brain tumor received a second round of targeted radiation to the trigeminal nerve.

Contribution

The paper presents a novel clinical approach to re-radiosurgery for trigeminal neuralgia after prior irradiation of an abutting meningioma.

Findings

A second radiosurgery course targeting cranial nerve V improved symptoms in a patient with refractory trigeminal neuralgia.

Radiobiological and technical challenges were addressed in the reirradiation setting.

Multidisciplinary and patient-centered factors are critical in such cases.

Abstract

Trigeminal neuralgia is a common symptom of benign tumors compressing the trigeminal nerve, leading to debilitating pain and a devastating impact on quality of life. Stereotactic radiosurgery is a validated option for intracranial meningiomas with excellent tumor control rates that correlate with symptomatic improvement. Select cases with refractory or recurrent trigeminal neuralgia can benefit from a second treatment targeting the trigeminal nerve. We present a case of refractory trigeminal neuralgia secondary to compression of a previously irradiated petroclival meningioma successfully treated with a second radiosurgery course targeting cranial nerve V (CN V). Multidisciplinary considerations, patient-centered factors, radiobiological considerations, and technical challenges faced in the intracranial reirradiation setting when cumulative dose constraints are previously met or exceeded are discussed.

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