Objective

Subsequent microvascular decompression (MVD) might be affected by the previous two-isocentre gamma knife radiosurgery (GKS) due to the tissue changes caused by its higher dose radiation and larger treatment volume. This study aimed to evaluate the safety and efficacy of MVD as a second step treatment after two-isocentre GKS.

Methods

Between December 2016 and May 2019, data from 19 consecutive trigeminal neuralgia (TN) patients who experienced MVD after failed two-isocentre GKS were collected. The clinical characteristics, intraoperative findings, surgical outcomes and complications were reviewed and compared with 158 patients who underwent MVD as an initial treatment.

Results

Fifteen patients (78.9%) achieved complete pain relief (Barrow Neurological Institute, BNI class I) immediately after surgery and nine patients (47.4%) maintained complete pain relief at the last follow-up, which was similar to patients who underwent initial MVD. The median follow-up period was 36 months. The incidence of new or worsened facial numbness showed no statistical significance between the groups. During surgery, trigeminal nerve atrophy was noted in 9 patients (47.4%), thickened arachnoid in 3 patients (15.8%), atherosclerotic plaque in 3 patients (15.8%) and neurovascular adhesion in 1 patient (5.3%).

Conclusions

MVD remains an effective and safe rescue therapy for patients who elect the minimally invasive treatment with two-isocentre GKS for the first time, without an increased risk of facial numbness.

中文翻译：

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微血管减压作为双等中心伽马刀放射外科手术失败患者三叉神经痛的第二步治疗

客观的

随后的微血管减压术（MVD）可能会受到之前的双等中心伽马刀放射外科（GKS）的影响，因为其更高剂量的辐射和更大的治疗量会引起组织变化。本研究旨在评估 MVD 作为双等中心 GKS 后第二步治疗的安全性和有效性。

方法

在 2016 年 12 月至 2019 年 5 月期间，收集了 19 名在双等中心 GKS 失败后经历 MVD 的连续三叉神经痛 (TN) 患者的数据。回顾了临床特征、术中发现、手术结果和并发症，并与 158 名接受 MVD 作为初始治疗的患者进行了比较。

结果

15 名患者（78.9%）在手术后立即完全缓解疼痛（Barrow 神经病学研究所，BNI 一级），9 名患者（47.4%）在最后一次随访中保持完全疼痛缓解，这与接受初始 MVD 的患者相似。中位随访时间为 36 个月。新发或恶化的面部麻木发生率在各组之间无统计学意义。术中发现三叉神经萎缩9例（47.4%），蛛网膜增厚3例（15.8%），动脉粥样硬化斑块3例（15.8%），神经血管粘连1例（5.3%）。

结论

对于首次选择双等中心 GKS 微创治疗的患者，MVD 仍然是一种有效且安全的抢救治疗，不会增加面部麻木的风险。