Stereotactic Radiosurgery for Medically Refractory Trigeminal Neuralgia Secondary to Stroke: A Systematic Review and Clinical Case Presentation.

Autor: Zamarud A; Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA., Park DJ; Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA., Ung TH; Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA., McCleary TL; Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA., Yoo KH; Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA., Soltys SG; Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA., Lim M; Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA., Chang SD; Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA., Meola A; Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA. Electronic address: ameola@stanford.edu.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2023 Nov; Vol. 179, pp. e366-e373. Date of Electronic Publication: 2023 Aug 26.
DOI: 10.1016/j.wneu.2023.08.092
Abstrakt: Background: Trigeminal neuralgia (TN) is a paroxysmal, unilateral, brief, shock-like pain in ≥1 divisions of the trigeminal nerve. It can result from multiple causes; however, TN secondary to stroke is very rare.
Methods: We present the case of TN secondary to pontine infarction treated with incremental doses of neuropathic pain medication for >5 years before conservative management failed. He was then treated with stereotactic radiosurgery (SRS). Additionally, we conducted a systematic review using standard PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines for all the cases of TN with brainstem stroke from 1976 to 2022.
Results: Our patient was an 82-year-old man. Magnetic resonance imaging demonstrated a pontine lesion consistent with stroke. The Barrow Neurological Institute (BNI) score at presentation was 5. He received a marginal dose of 60 Gy to the 80% isodose line in a single fraction to a volume of 0.05 cm 3 . The immediate post-treatment BNI score was 0 and remained at 0 for 3 months, when he experienced recurrence. The recurrence was treated with oxcarbazepine. His pain remained well controlled with a lower dose of oxcarbazepine, and he had no adverse effects at 1 year of follow-up with a BNI score of 3. The systemic review identified 21 case reports with a combined cohort of 25 patients with TN secondary to stroke. Only 3 patients were treated with SRS, 2 of whom reported symptom improvement at 6 months and 8 months of follow-up with no adverse events.
Conclusions: Our case and literature review demonstrate durable and effective treatment with SRS, which can be considered a safe and effective treatment option for patients with stroke-associated TN.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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