Romanelli Pantaleo, Beltramo Giancarlo
Neurosurgery, Cyberknife Center, Centro Diagnostico Italiano, Milan, ITA.
Radiation Oncology, Cyberknife Center, Centro Diagnostico Italiano, Milan, ITA.
Cureus. 2022 Apr 11;14(4):e24021. doi: 10.7759/cureus.24021. eCollection 2022 Apr.
Background Spasticity is a major health problem worldwide. Response to current medical and rehabilitation treatments is often poor. Surgical treatment is available only for a very limited number of patients. Aim We recently reported the application of stereotactic radiosurgery as a treatment option for spasticity and related pain. This paper describes a larger experience using image-guided stereotactic radiosurgery targeting the cervical or lumbar spinal roots to relieve spasticity and pain in four patients. Methods All the patients had refractory spasticity and related pain, one patient had additional paroxystic neuralgic pain. The cause of spasticity and pain was a traumatic brain and/or spinal cord injury, brain and/or spinal cord surgery, and stroke. Symptoms affected the right superior limb in one patient, and the inferior limbs in three patients (unilaterally in two, bilaterally in one). According to the symptoms, one patient was treated at the cervical level (C7 right sensory root) and three patients at lumbar level (right L4, left S1, and L2 roots bilaterally). The target was selected on constructive interference in steady-state (CISS) MR, focusing the irradiation on the postganglionic sensory segment of the cervical root or the intra-foraminal dorsolateral sensory portion of the lumbar roots. Appropriate spasticity and pain scales were used to assess the patient's status after the treatment. Results The treatments were tolerated well. Marked symptomatic relief was found in all the treated patients. Improvements in spasticity and pain scales were observed up to the latest follow-up. After 2 years, the mean reduction of the visual analog scale (VAS) and Modified Ashworth Scale (MAS) was 64.3% and 43.7%, respectively, while the median reduction of MAS score was 50%. Conclusions Except for a previous case report, this is the first study describing a novel noninvasive technique based on image-guided radiosurgery to treat severe spasticity and pain due to brain and spinal cord injury. This novel technique appears to be safe and effective and deserves to be studied further.
痉挛是全球范围内的一个主要健康问题。目前的药物和康复治疗效果往往不佳。手术治疗仅适用于极少数患者。目的：我们最近报道了立体定向放射外科作为痉挛及相关疼痛的一种治疗选择。本文描述了一项针对4例患者，使用图像引导立体定向放射外科靶向颈或腰脊神经根以缓解痉挛和疼痛的更大规模经验。方法：所有患者均患有难治性痉挛及相关疼痛，1例患者还伴有阵发性神经痛。痉挛和疼痛的病因是创伤性脑和/或脊髓损伤、脑和/或脊髓手术以及中风。症状影响1例患者的右上肢，3例患者的下肢（2例为单侧，1例为双侧）。根据症状，1例患者在颈部水平（右侧C7感觉根）接受治疗，3例患者在腰部水平（右侧L4、左侧S1以及双侧L2神经根）接受治疗。靶点在稳态构成干扰（CISS）磁共振成像上选定，将照射聚焦于颈神经根的节后感觉段或腰神经根的椎间孔背外侧感觉部分。使用适当的痉挛和疼痛量表评估治疗后患者的状况。结果：治疗耐受性良好。所有接受治疗的患者均有明显的症状缓解。直至最近一次随访，痉挛和疼痛量表均有改善。2年后，视觉模拟量表（VAS）和改良Ashworth量表（MAS）的平均降低分别为64.3%和43.7%，而MAS评分的中位数降低为50%。结论：除之前的一篇病例报告外，这是第一项描述基于图像引导放射外科治疗脑和脊髓损伤所致严重痉挛和疼痛的新型非侵入性技术的研究。这项新技术似乎安全有效，值得进一步研究。
