Linear Accelerator (LINAC)-Based Stereotactic Radiosurgery Using a Virtual Cone Technique for Refractory Trigeminal Neuralgia: A Case Series

Trigeminal neuralgia (TN) is a debilitating craniofacial pain disorder that may become refractory to medical therapy.This case series describes five female patients with medically refractory TN treated with stereotactic radiosurgery (SRS) using a multileaf collimator-based virtual cone technique on a linear accelerator (LINAC).The mean age was 68.8 years (range: 55-78 years), and prescription doses ranged from 60 to 90 Gy in a single fraction.All patients achieved complete early pain relief, with visual analog scale (VAS) scores decreasing to 0/10 within three months.No acute treatment-related neurological toxicity was observed during the sixmonth follow-up.These findings support the feasibility of this approach, with favorable short-term pain control and tolerability.The virtual cone technique may facilitate the implementation of SRS for TN on appropriately equipped LINAC platforms by avoiding the need for dedicated physical stereotactic cone hardware.Larger studies with longer follow-up are needed to assess recurrence and late toxicity.