Lee Seunghoon, Lee Jung-Il
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Korean Neurosurg Soc. 2022 Sep;65(5):633-639. doi: 10.3340/jkns.2021.0303. Epub 2022 Jul 1.
Accurate diagnosis of trigeminal neuralgia (TN) is the starting point for optimal treatment. Gamma knife radiosurgery (GKRS) is currently regarded as one of the first-line treatment options for medically refractory TN. GKRS is a less invasive treatment with a low risk of complications than other surgical procedures that provides a favorable pain control (BNI I-IIIb) rate of >75% at short-term follow-up. Drawbacks of GKRS include the latency period before pain relief and higher recurrence rate compared with microvascular decompression. Therefore, repeat treatment is necessary if the initial GKRS was effective but followed by recurrence. The concept of dose rate and the biologically effective dose of radiation has been actively studied in radiation oncology and is also applied in GKRS for TN to achieve high safety and efficacy by prescribing the optimal dose. Recent progress in functional imaging, such as diffusion tensor imaging, enables us to understand the pathophysiology of TN and predict the clinical outcome after GKRS. Here, we review TN, GKRS, and recent updates, especially in the concepts of radiation dose, diffusion tensor imaging studies, and repeat treatment in GKRS for TN.
准确诊断三叉神经痛（TN）是优化治疗的起点。伽玛刀放射外科手术（GKRS）目前被视为药物难治性TN的一线治疗选择之一。与其他外科手术相比，GKRS是一种侵入性较小的治疗方法，并发症风险较低，在短期随访中能提供>75%的良好疼痛控制（BNI I-IIIb）率。GKRS的缺点包括疼痛缓解前的潜伏期以及与微血管减压相比更高的复发率。因此，如果初始GKRS有效但随后复发，则需要重复治疗。放射肿瘤学中积极研究了剂量率和辐射生物有效剂量的概念，并且该概念也应用于TN的GKRS，通过规定最佳剂量来实现高安全性和有效性。功能成像的最新进展，如扩散张量成像，使我们能够了解TN的病理生理学并预测GKRS后的临床结果。在此，我们回顾TN、GKRS及其最新进展，特别是在辐射剂量概念、扩散张量成像研究以及TN的GKRS重复治疗方面。
