Texakalidis Pavlos, Tora Muhibullah S, Boulis Nicholas M
Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA,
Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Stereotact Funct Neurosurg. 2019;97(1):55-65. doi: 10.1159/000499476. Epub 2019 Apr 17.
BACKGROUND/AIMS: Postherpetic neuralgia (PHN) can be refractory to both medical and minimally invasive treatments. Its complex pathophysiology explains the numerous neurosurgical procedures that have been implemented through the years. Our objective was to summarize all available neurosurgical strategies for the management of resistant PHN and evaluate their respective safety and efficacy outcomes.
A comprehensive systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
A total of 38 studies comprising 811 patients with refractory PHN were included. The safety and efficacy of the following procedures were investigated: spinal cord stimulation (SCS), dorsal root entry zone (DREZ) lesioning, intrathecal drug delivery, caudalis DREZ lesioning, dorsal root ganglion (DRG) radiofrequency lesioning, peripheral nerve stimulation, gamma knife surgery, deep brain stimulation, cordotomy, percutaneous radiofrequency rhizotomy and Gasserian ganglion stimulation.
There are several available neurosurgical approaches for recalcitrant PHN including neuromodulatory and ablative procedures. It is suggested that patients with resistant PHN undergo minimally invasive procedures first, including SCS, peripheral nerve stimulation or DRG radiofrequency lesioning. More invasive procedures should be reserved for refractory cases. Comparative studies are needed in order to construct a PHN neurosurgical management algorithm.
背景/目的：带状疱疹后神经痛（PHN）对药物治疗和微创治疗均可能无效。其复杂的病理生理学解释了多年来实施的众多神经外科手术。我们的目的是总结所有可用于治疗难治性PHN的神经外科策略，并评估它们各自的安全性和疗效结果。
根据系统评价和Meta分析的首选报告项目（PRISMA）指南进行了全面的系统评价。
共纳入38项研究，涉及811例难治性PHN患者。对以下手术的安全性和疗效进行了研究：脊髓刺激（SCS）、背根入区（DREZ）毁损、鞘内药物输注、尾侧DREZ毁损、背根神经节（DRG）射频毁损、周围神经刺激、伽玛刀手术、深部脑刺激、脊髓切断术、经皮射频神经根切断术和半月神经节刺激。
对于顽固性PHN有几种可用的神经外科方法，包括神经调节和毁损手术。建议难治性PHN患者首先接受微创手术，包括SCS、周围神经刺激或DRG射频毁损。更具侵入性的手术应保留给难治性病例。需要进行比较研究以构建PHN神经外科治疗算法。
