Skip to main content
Journal cover image

Cyberknife targeting the pterygopalatine ganglion for the treatment of chronic cluster headaches.

Publication ,  Journal Article
Lad, SP; Lipani, JD; Gibbs, IC; Chang, SD; Adler, JR; Henderson, JM
Published in: Neurosurgery
March 2007

OBJECTIVE: Cluster headache (CH) is a severe unilateral and periorbital facial pain syndrome that is often associated with autonomic symptoms, including ipsilateral lacrimation, nasal congestion, conjunctival injection, miosis, ptosis, and eyelid edema. We evaluated the treatment of medically refractory CH with CyberKnife (Accuray, Inc., Sunnyvale, CA) stereotactic radiosurgery targeting the pterygopalatine ganglion. CLINICAL PRESENTATION: A 56-year-old man presented with a 20-year history of medically refractory CH. His symptoms were described as left-sided, severe, stabbing, burning, and often being associated with tearing and rhinorrhea. These headaches occurred virtually every morning and interfered with sleep, lifestyle, and work performance. INTERVENTION: The patient underwent two pterygopalatine nerve block trials, both of which resulted in the complete relief of headaches for a 24-hour period. Contrast-enhanced computed axial tomography and magnetic resonance imaging scans were fused for target identification and treatment planning. The target volume measured 0.296 cm3 and a single fraction of 45.50 Gy was delivered to the 78% isodose line with a maximum dose of 65 Gy. The patient kept a detailed diary of his headaches and was followed for 12 months after treatment. CONCLUSION: Results of CyberKnife targeting of the pterygopalatine ganglion in a patient with medically intractable CHs have revealed a significant decrease in the severity and frequency of headaches after a 12-month follow-up period. In addition, the patient has been able to reduce his medication intake, allowing for a significant decrease in medication-related side effects. Longer follow-up periods and additional studies are required to determine the long-term efficacy and late side effects of this treatment strategy.

Duke Scholars

Published In

Neurosurgery

DOI

EISSN

1524-4040

Publication Date

March 2007

Volume

60

Issue

3

Start / End Page

E580 / E581

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Neurology & Neurosurgery
  • Nerve Block
  • Middle Aged
  • Male
  • Laser Therapy
  • Humans
  • Ganglia, Parasympathetic
  • Cluster Headache
  • 5202 Biological psychology
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Lad, S. P., Lipani, J. D., Gibbs, I. C., Chang, S. D., Adler, J. R., & Henderson, J. M. (2007). Cyberknife targeting the pterygopalatine ganglion for the treatment of chronic cluster headaches. Neurosurgery, 60(3), E580–E581. https://doi.org/10.1227/01.NEU.0000255348.33582.DE
Lad, Shivanand P., John D. Lipani, Iris C. Gibbs, Steven D. Chang, John R. Adler, and Jaimie M. Henderson. “Cyberknife targeting the pterygopalatine ganglion for the treatment of chronic cluster headaches.Neurosurgery 60, no. 3 (March 2007): E580–81. https://doi.org/10.1227/01.NEU.0000255348.33582.DE.
Lad SP, Lipani JD, Gibbs IC, Chang SD, Adler JR, Henderson JM. Cyberknife targeting the pterygopalatine ganglion for the treatment of chronic cluster headaches. Neurosurgery. 2007 Mar;60(3):E580–1.
Lad, Shivanand P., et al. “Cyberknife targeting the pterygopalatine ganglion for the treatment of chronic cluster headaches.Neurosurgery, vol. 60, no. 3, Mar. 2007, pp. E580–81. Pubmed, doi:10.1227/01.NEU.0000255348.33582.DE.
Lad SP, Lipani JD, Gibbs IC, Chang SD, Adler JR, Henderson JM. Cyberknife targeting the pterygopalatine ganglion for the treatment of chronic cluster headaches. Neurosurgery. 2007 Mar;60(3):E580–E581.
Journal cover image

Published In

Neurosurgery

DOI

EISSN

1524-4040

Publication Date

March 2007

Volume

60

Issue

3

Start / End Page

E580 / E581

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Neurology & Neurosurgery
  • Nerve Block
  • Middle Aged
  • Male
  • Laser Therapy
  • Humans
  • Ganglia, Parasympathetic
  • Cluster Headache
  • 5202 Biological psychology