Franzini Andrea, Ninatti Gaia, Rossini Zefferino, Tropeano Maria Pia, Clerici Elena, Navarria Pierina, Pessina Federico, Picozzi Piero
Department of Neurosurgery, IRCCS Humanitas Research Hospital, Rozzano, Italy.
Department of Biomedical Sciences, Humanitas University, Rozzano, Italy.
Neurosurgery. 2023 Feb 1;92(2):363-369. doi: 10.1227/neu.0000000000002211. Epub 2022 Nov 10.
Chronic neuropathic pain can be severely disabling and is difficult to treat. The medial thalamus is believed to be involved in the processing of the affective-motivational dimension of pain, and lesioning of the medial thalamus has been used as a potential treatment for neuropathic pain. Within the medial thalamus, the central lateral nucleus has been considered as a target for stereotactic lesioning.
To study the safety and efficacy of central lateral thalamotomy using Gamma Knife radiosurgery (GKRS) for the treatment of neuropathic pain.
We retrospectively reviewed all patients with neuropathic pain who underwent central lateral thalamotomy using GKRS. We report on patient outcomes, including changes in pain scores using the Numeric Pain Rating Scale and Barrow Neurological Institute pain intensity score, and adverse events.
Twenty-one patients underwent central lateral thalamotomy using GKRS between 2014 and 2021. Meaningful pain reduction occurred in 12 patients (57%) after a median period of 3 months and persisted in 7 patients (33%) at the last follow-up (the median follow-up was 28 months). Rates of pain reduction at 1, 2, 3, and 5 years were 48%, 48%, 19%, and 19%, respectively. Meaningful pain reduction occurred more frequently in patients with trigeminal deafferentation pain compared with all other patients (P = .009). No patient had treatment-related adverse events.
Central lateral thalamotomy using GKRS is remarkably safe. Pain reduction after this procedure occurs in a subset of patients and is more frequent in those with trigeminal deafferentation pain; however, pain recurs frequently over time.
慢性神经性疼痛会严重致残且难以治疗。内侧丘脑被认为参与疼痛情感 - 动机维度的处理，内侧丘脑毁损术已被用作神经性疼痛的一种潜在治疗方法。在内侧丘脑中，中央外侧核被视为立体定向毁损的靶点。
研究使用伽玛刀放射外科手术（GKRS）进行中央外侧丘脑切开术治疗神经性疼痛的安全性和有效性。
我们回顾性分析了所有接受GKRS中央外侧丘脑切开术的神经性疼痛患者。我们报告患者的治疗结果，包括使用数字疼痛评分量表和巴罗神经学研究所疼痛强度评分评估的疼痛评分变化以及不良事件。
2014年至2021年间，21例患者接受了GKRS中央外侧丘脑切开术。12例患者（57%）在中位时间3个月后疼痛有显著减轻，在最后一次随访时（中位随访时间为28个月），7例患者（33%）仍保持疼痛减轻。1年、2年、3年和5年时的疼痛减轻率分别为48%、48%、19%和19%。与所有其他患者相比，三叉神经去传入性疼痛患者更常出现显著的疼痛减轻（P = 0.）。没有患者发生与治疗相关的不良事件。
使用GKRS进行中央外侧丘脑切开术非常安全。部分患者术后疼痛减轻，三叉神经去传入性疼痛患者更常出现疼痛减轻；然而，随着时间推移疼痛经常复发。
