Radiotherapy Unit, Department of Radiosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Via Giovanni Celoria, 11, 20133, Milano, Italy.
Neurol Sci. 2019 May;40(Suppl 1):153-157. doi: 10.1007/s10072-019-03814-6.
The trigeminal neuralgia (TN) is a chronic, episodic, and disabling facial pain syndrome. It is a relatively rare disorder. Despite this, because of the intensity of the pain, TN may have a dramatic impact for many patients. Fortunately, most of the patients may obtain a good pain relief simply by taking drugs. Historically, the surgical approaches represent a true treatment paradigm for all the drug-resistant TN. In this context, radiosurgery (RS) is a relatively new treatment modality. The effectiveness and safety of radiosurgery are today widely accepted and the technique can be proposed to many patients which suffer from a drug-resistant TN. This is true especially when the patients are less than ideal candidates for an open surgery, or for elderly ones, when a clear neuro-vascular conflict is not evident. The present review provides a concise analysis of the actual indications for radiosurgery, as well as the most acknowledged prognostic factors. The pathogenesis of TN and the rationale for the RS efficacy are also investigated and described. Some technical aspects including the target selection and the prescription doses, which have widely changed in time, are depicted. In conclusion, the present review supports the idea that TN is a complex disease and radiosurgery represents an effective and relatively new treatment modality, which enriches the treatment armamentarium for these unfortunate patients. To optimize the RS results, a correct patient selection has to be performed.
三叉神经痛（TN）是一种慢性、阵发性、致残性面部疼痛综合征。它是一种相对罕见的疾病。尽管如此，由于疼痛的强度，TN 可能会对许多患者产生巨大影响。幸运的是，大多数患者只需服药即可获得良好的止痛效果。从历史上看，手术方法代表了所有耐药性 TN 的真正治疗范例。在这种情况下，放射外科（RS）是一种相对较新的治疗方式。RS 的有效性和安全性已被广泛接受，该技术可用于许多耐药性 TN 患者。当患者不太适合开放手术或患者为老年人且无明显的神经血管冲突时，尤其如此。本文综述简要分析了 RS 的实际适应证以及最公认的预后因素。还研究和描述了 TN 的发病机制和 RS 疗效的基本原理。描述了一些技术方面，包括目标选择和处方剂量，这些方面随着时间的推移发生了广泛变化。总之，本文综述支持以下观点，即 TN 是一种复杂的疾病，RS 是一种有效且相对较新的治疗方式，为这些不幸的患者提供了更多的治疗手段。为了优化 RS 的结果，必须进行正确的患者选择。
