Berti Aldo, Ibars George, Wu Xiaodong, Sabo Alex, Granville Michelle, Suarez Gail, Schwade James G, Jacobson Robert E
Department Neurosurgery, University of Miami Hospital, Miami, USA.
Neurosurgery, South Miami Hospital, Cyberknife Center of Miami.
Cureus. 2018 May 9;10(5):e2598. doi: 10.7759/cureus.2598.
Stereotactic radiosurgery (SRS) has evolved as an accepted treatment for medication resistant trigeminal neuralgia. Initial results are very good but follow-up over three to five years shows a gradual return of pain in up to 50% of treated patients, often requiring further treatment. The results with repeat SRS using the isocentric Gamma Knife (GK) (Elekta, Stockholm, Sweden), especially in patients having initially good results, are very similar to the outcomes after the initial treatment although there is an increased risk of residual facial numbness secondary to the additional radiation dose to the trigeminal nerve. However, after 2000, non-isocentric SRS systems began to be used for treating trigeminal neuralgia including the CyberKnife (CK) (Accuray, Sunnyvale, California) as well as various linear accelerator (LINAC) based systems. This report specifically examines a series of recurrent trigeminal cases treated by the same group of physicians with the CK system. Similar doses and locations on the trigeminal nerve and/or the root entry zone were used for both initial and repeat SRS treatment regardless of system used. Although there are numerous series reporting the use of GK for recurrent treatment for recurrent trigeminal neuralgia, there are no series reviewing the results and long-term effectiveness using CK for repeat SRS for recurrent trigeminal pain. We reviewed 23 cases that had initial treatment for trigeminal neuralgia either surgically or with SRS with either the GK or CK and then a later second procedure only with CK. The follow-up after the second CK SRS ranged from three to 13 years found that the results are very similar to the multiple reports in the literature describing second or third SRS treatments with the GK. Results of repeat radiosurgery treatment of recurrent trigeminal neuralgia appear to be independent of the system used and are primarily based on proper target and dose to the trigeminal nerve.
立体定向放射外科手术（SRS）已发展成为药物难治性三叉神经痛的一种公认治疗方法。初始治疗效果非常好，但三到五年的随访显示，高达50%的接受治疗患者的疼痛会逐渐复发，通常需要进一步治疗。使用等中心伽玛刀（GK）（瑞典斯德哥尔摩的医科达公司）进行重复SRS治疗的结果，尤其是在最初效果良好的患者中，与初始治疗后的结果非常相似，尽管由于对三叉神经额外的辐射剂量，面部残留麻木的风险增加。然而，2000年以后，非等中心SRS系统开始用于治疗三叉神经痛，包括射波刀（CK）（美国加利福尼亚州森尼韦尔市的Accuray公司）以及各种基于直线加速器（LINAC）的系统。本报告专门研究了同一组医生使用CK系统治疗的一系列复发性三叉神经病例。无论使用何种系统，初始和重复SRS治疗在三叉神经和/或神经根入区的剂量和位置相似。尽管有许多系列报道使用GK进行复发性三叉神经痛的重复治疗，但尚无系列研究评估使用CK进行复发性三叉神经痛重复SRS治疗的结果和长期有效性。我们回顾了23例最初接受三叉神经痛手术或使用GK或CK进行SRS治疗，随后仅使用CK进行第二次手术的病例。第二次CK SRS后的随访时间为三到十三年，结果发现与文献中描述使用GK进行第二次或第三次SRS治疗的多篇报告非常相似。复发性三叉神经痛的重复放射外科治疗结果似乎与所使用的系统无关，主要取决于对三叉神经的适当靶点和剂量。
