Radiosurgery for classical trigeminal neuralgia: impact of the shot size on clinical outcome.

Autor: Ortholan C; Department of Radiotherapy, Centre Hospitalier Princesse Grace, Monaco, Monaco. Cecile.ortholan@chpg.mc.; Department of Radiation Oncology, Centre Hospitalier Princesse Grace, Monaco, 98000, Monaco. Cecile.ortholan@chpg.mc., Colin P; Department of Radiotherapy, Centre Hospitalier Princesse Grace, Monaco, Monaco., Serrano B; Department of Medical Physics, Centre Hospitalier Princesse Grace, Monaco, Monaco., Bouet T; Pain Clinic, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France., Garnier N; Department of Medical Physics, Centre Hospitalier Princesse Grace, Monaco, Monaco., le Guyader M; Department of Radiotherapy, Centre Hospitalier Princesse Grace, Monaco, Monaco., Amblard R; Department of Medical Physics, Centre Hospitalier Princesse Grace, Monaco, Monaco., Villeneuve R; Department of Medical Physics, Centre Hospitalier Princesse Grace, Monaco, Monaco., Chanalet S; Department of Radiology, Centre Hospitalier Princesse Grace, Monaco, Monaco.; Department of Radiology, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France., Alchaar H; Pain Clinic, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France., Bozzolo E; Pain Clinic, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France.; FHU Inovpain, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France., Lanteri-Minet M; Pain Clinic, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France.; FHU Inovpain, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France.; INSERM/UdA, U1107, Neuro-Dol, Trigeminal Pain and Migraine, University Clermont-Auvergne, Clermont-Ferrand, France., Fontaine D; FHU Inovpain, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France.; Department of Neurosurgery, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France.
Jazyk: angličtina
Zdroj: The journal of headache and pain [J Headache Pain] 2023 May 11; Vol. 24 (1), pp. 51. Date of Electronic Publication: 2023 May 11.
DOI: 10.1186/s10194-023-01583-4
Abstrakt: Background: This study compares the outcome of patients suffering from medically refractory classical trigeminal neuralgia (TN) after treatment with radiosurgery using two different shot sizes (5- and 6-mm).
Methods: All patients included in this open, prospective, non-controlled study were treated in a single institution for TN (95 cases in 93 patients) with LINear ACcelerators (LINAC) single-dose radiosurgery using a 5-mm shot (43 cases) or 6-mm shot (52 cases). The target was positioned on the intracisternal part of the trigeminal nerve.
Results: The mean Dmax (D0.035) to the brainstem was higher in the 6-mm group: 12.6 vs 21.3 Gy (p < 0.001). Pain relief was significantly better in the 6-mm group: at 12 and 24 months in the 6-mm group the rate of pain-free patients was 90.2 and 87.8%, respectively vs. 73.6 and 73.6% in the 5-mm group (p = 0.045). At 12 and 24 months post-radiosurgical hypoesthesia was more frequent in the 6-mm group: 47.0 and 58% vs.11.3 and 30.8% in the 5-mm group (p = 0.002). To investigate the effect of cone diameter and the dose to the brainstem on outcomes, patients were stratified into three groups: group 1 = 5-mm shot, (all Dmax < 25 Gy, 43 cases), group 2 = 6-mm shot, Dmax < 25 Gy (32 cases), group 3 = 6-mm shot Dmax > 25 Gy (20 cases). At 12 months the rates of hypoesthesia were 11.3, 33.5 and 76.0%, respectively in groups 1, 2 and 3 (p < 0.001) and the rates of recurrence of pain were 26.4, 16.5 and 5%, respectively, (p = 0.11).
Conclusion: LINAC treatment with a 6-mm shot provided excellent control of pain, but increased the rate of trigeminal nerve dysfunction, especially when the maximum dose to the brainstem was higher than 25 Gy.
(© 2023. The Author(s).)
Databáze: MEDLINE
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