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Factors affecting long-lasting pain relief after Gamma Knife radiosurgery for trigeminal neuralgia: a single institutional analysis and literature review
Neurosurgical Review ( IF 2.8 ) Pub Date : 2021-01-12 , DOI: 10.1007/s10143-021-01474-9
Lina R Barzaghi 1 , Luigi Albano 1, 2 , Claudia Scudieri 1 , Carmen R Gigliotti 3 , Antonella Del Vecchio 3 , Pietro Mortini 1
Affiliation  

Gamma Knife radiosurgery (GKRS) is a well-established safe and effective treatment for trigeminal neuralgia (TN) with high initial success rate (80–90%). Why the pain relief is progressively decreased with time is a matter of considerable debate. To investigate factors related to long-lasting pain relief, the authors conducted a retrospective analysis focusing on anatomical and radiosurgical related parameters, chosen according to literature review. One hundred and twelve patients with classical trigeminal neuralgia and follow-up longer than 12 months were selected from our institutional consecutive series of patients treated by GKRS. Patients were followed for a mean period of 61.5 ± 3.5 months (range, 12–126 months) to evaluate, as endpoints, long-term pain relief and hypoesthesia onset. The median maximum radiation dose was 80 Gy (range 70–90 Gy). Factors related to poor long-term pain relief were prescription dose < 80 Gy (p = 0.038), calibration dose rate < 2.5 Gy/min (p = 0.018), and distance between isocenter and trigeminal nerve emergence > 8 mm (p < 0.001). When analyzing patients who received 80 Gy as maximum dose without any sector blocking, we notice that ID50 < 2.7 mJ was predictive for longer period of pain control (p = 0.043). It was experienced also among patients in which a small volume of the nerve (< 35%) received more than 80% of the maximal dose, compared to those in which a larger volume of the nerve was irradiated with maximal dose (p 0.034). This last result was significant if the shot was 8 mm or less from the pons. Several single-patient anatomical and radiosurgical parameters should be considered to improve GKRS effectiveness.



中文翻译:

影响三叉神经痛伽玛刀放射外科手术后持久疼痛缓解的因素:单一机构分析和文献综述

伽玛刀放射外科 (GKRS) 是一种行之有效的安全有效的三叉神经痛 (TN) 治疗方法,具有很高的初始成功率 (80-90%)。为什么疼痛缓解会随着时间的推移逐渐减少是一个颇有争议的问题。为了调查与长期疼痛缓解相关的因素,作者进行了一项回顾性分析,重点关注解剖学和放射外科相关参数,根据文献综述选择。从我们接受 GKRS 治疗的机构连续系列患者中选择了 112 名患有经典三叉神经痛且随访时间超过 12 个月的患者。对患者进行平均 61.5 ± 3.5 个月(范围,12-126 个月)的随访,以评估长期疼痛缓解和感觉减退的发生作为终点。中位最大辐射剂量为 80 Gy(范围 70-90 Gy)。与长期疼痛缓解不佳相关的因素是处方剂量 < 80 Gy(p = 0.038),校准剂量率 < 2.5 Gy/min ( p = 0.018),等中心和三叉神经出现之间的距离 > 8 mm ( p < 0.001)。在分析接受 80 Gy 作为最大剂量且没有任何扇区阻塞的患者时,我们注意到 ID 50 < 2.7 mJ 可预测疼痛控制更长时间(p = 0.043)。与用最大剂量照射较大体积神经的患者相比,在小体积神经(< 35%)接受超过 80% 最大剂量的患者中也有这种情况(p0.034)。如果射击距离脑桥 8 毫米或更小,则最后一个结果很重要。应考虑几个单一患者的解剖和放射外科参数以提高 GKRS 的有效性。

更新日期:2021-01-12
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