Lorenzoni José, David Philippe, Levivier Marc
Department of Neurosurgery, School of Medicine, Pontificia Universidad Católica de Chile, Chile.
Clin Neurol Neurosurg. 2011 Nov;113(9):758-61. doi: 10.1016/j.clineuro.2011.08.013. Epub 2011 Sep 8.
To study with a non invasive method any potential radiological change on the superior cerebellar artery (SCA) in patients treated radiosurgically for classic trigeminal neuralgia (CTN).
A retrospective measure of maximal dose received by SCA was performed analyzing the treatment planning in 55 consecutive patients treated by Gamma Knife radiosurgery for an CTN, then, a prospective study was designed using high resolution MR, with T2 SPIR, T1 without and with gadolinium enhancement, Proton density, 3D TONE and MIP reconstructions. Inclusion criteria were: patients followed at our institution, follow-up of one year or more, dose received by the SCA of 15 Gy or more and voluntary patient participation in the study. Patients with repeated Gamma Knife radiosurgery for failure or recurrence were excluded. The end points were: SCA occlusion, stenosis or infarction in the territory supplied by SCA.
Sixteen patients were studied, with a mean follow-up of 25.2 months (12-42 months). The mean maximal dose received by the SCA was 57.5 Gy. (15-87 Gy). Among these 16 patients studied, neither obstruction of the SCA nor infarction was demonstrated. In one patient a suspicion of asymptomatic SCA stenosis was visualized distant to the irradiation field.
SCA can receive a high dose of irradiation during radiosurgical treatment for CTN. This study does not confirm any vascular damage to the SCA after radiosurgery for CTN.
采用非侵入性方法研究接受经典三叉神经痛（CTN）放射外科治疗的患者小脑上动脉（SCA）的任何潜在放射学变化。
对55例连续接受伽玛刀放射外科治疗CTN的患者的治疗计划进行回顾性测量，分析SCA接受的最大剂量，然后设计一项前瞻性研究，使用高分辨率磁共振成像，包括T2脂肪抑制成像、T1加权像（平扫及钆增强）、质子密度加权像、三维薄层容积激发快速扰相梯度回波序列和最大密度投影重建。纳入标准为：在本机构随访的患者、随访一年或更长时间、SCA接受的剂量为15 Gy或更高以及患者自愿参与研究。排除因治疗失败或复发而接受重复伽玛刀放射外科治疗的患者。观察终点为：SCA闭塞、狭窄或SCA供血区域梗死。
研究了16例患者，平均随访25.2个月（12 - 42个月）。SCA接受的平均最大剂量为57.5 Gy（15 - 87 Gy）。在这16例研究患者中，未发现SCA阻塞或梗死。1例患者在距照射野较远的部位可见疑似无症状SCA狭窄。
CTN放射外科治疗期间SCA可接受高剂量照射。本研究未证实CTN放射外科治疗后SCA存在任何血管损伤。
