Pain experience using conventional versus angled anterior posts during stereotactic head frame placement for radiosurgery

Abstract

Stereotactic frame placement for radiosurgery is assumed to be an uncomfortable experience. We developed angled anterior posts for the Leksell frame to avoid pin penetration of the temporalis muscle. This study aimed to determine the frequency of angled post requirement and quantify the patient pain experience from frame placement. We prospectively enrolled 63 patients undergoing radiosurgery. Angled posts were used when conventional post trajectory was posterior or within 3mm of the superior temporal line to avoid temporalis muscle penetration. Pain scores (0 to 10) were collected prior to frame placement, immediately after frame placement, before radiosurgery, after radiosurgery, and a day after radiosurgery. A total of 63 patients were enrolled: 33 (48%) patients required angled posts. Women were significantly more likely to require angled posts than men (60.0% versus 33.3%, respectively; p=0.034). Mean pain scores were very low, ranging from 0.33 to 2.23. There were no significant differences in pain outcomes between both groups at all time points. Stereotactic frame placement is not perceived to be a painful procedure. This information may be useful when counseling patients about the pain experience with frame application and the option of using angled anterior posts.

Keywords: Frame application; Leksell frame; Pain experience; Radiosurgery; Stereotactic frame.

Conflict of interest statement

Conflicts of Interest/Disclosures The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.

Copyright © 2014 Elsevier Ltd. All rights reserved.

Figures

Fig. 1

(A) Close-up view of anterior posts with angled holes of 5 degrees, 10 degrees, and 15 degrees with pins in place. The progressive angulations of the pins can be easily appreciated. (B) Complete view of anterior posts with angled holes of both negative and positive degrees for the left and right side. (This figure is available in colour at http://www.sciencedirect.com/.)

Fig. 2

Skin marks on a patient for 5 and 10 degree pin hole posts for a left-sided frame. The vertical line indicates the superior temporal line (STL). (This figure is available in colour at http://www.sciencedirect.com/.)

Fig. 3

Comparison of pain experiences among patients who received conventional and angled posts. Pain scores were stratified as low (0–4), moderate (5–7), and severe (8–10). There were no significant differences among the two groups for every time point measured, prior to pin placement (A), after pin placement (B), prior to radiosurgery (C), after radiosurgery (D), day after radiosurgery (E).