Barzaghi Lina R, Pompeo Edoardo, Albano Luigi, Del Vecchio Antonella, Mortini Pietro
Departments of Neurosurgery and Gamma Knife Radiosurgery.
Medical Physics; and.
J Neurosurg Case Lessons. 2021 Jul 26;2(4):CASE2191. doi: 10.3171/CASE2191.
Cluster-tic syndrome is a disorder characterized by the coexistence of symptoms related to both cluster headache and trigeminal neuralgia. Etiopathogenesis is not yet well defined. Medical treatment, including drugs for both cluster headache and trigeminal neuralgia, is the first therapeutic choice, whereas more invasive treatments are indicated in the case of pharmacological therapy failure or in the presence of drug side effects. To date, no randomized and/or large cohort trials describing Gamma Knife radiosurgery (GKRS) for cluster-tic syndrome are available, probably due to the syndrome's rarity.
The authors describe the case of a 76-year-old woman with refractory cluster-tic syndrome who underwent GKRS with double target (the retrogasserian portion of the trigeminal nerve and the sphenopalatine ganglion). The Numerical Rating Scale (NRS) of pain and the Barrow Neurological Institute (BNI) pain intensity score before treatment were 7 (up to 10 during paroxysmal pain attacks) and V, respectively. At last follow-up, 24 months after GKRS, the patient had discontinued her pain medications and NRS and BNI pain scores were 1 and I, respectively. No trigeminal sensory disorders were reported.
The present case shows that GKRS, in selected cases, could be an effective treatment in patients with refractory cluster-tic syndrome.
集束性抽搐综合征是一种以丛集性头痛和三叉神经痛相关症状并存为特征的疾病。病因发病机制尚未明确。药物治疗，包括用于丛集性头痛和三叉神经痛的药物，是首选治疗方法，而在药物治疗失败或存在药物副作用的情况下，则需要更具侵入性的治疗。迄今为止，可能由于该综合征罕见，尚无描述伽玛刀放射外科治疗（GKRS）集束性抽搐综合征的随机和/或大型队列试验。
作者描述了一名76岁患有难治性集束性抽搐综合征的女性患者的病例，该患者接受了双靶点（三叉神经半月节后根部分和蝶腭神经节）的GKRS治疗。治疗前疼痛数字评定量表（NRS）和巴罗神经学研究所（BNI）疼痛强度评分分别为7分（发作性疼痛发作时高达10分）和V级。在GKRS术后24个月的最后一次随访中，患者已停用止痛药物，NRS和BNI疼痛评分分别为1分和I级。未报告有三叉神经感觉障碍。
本病例表明，在某些特定病例中，GKRS可能是治疗难治性集束性抽搐综合征患者的有效方法。
