Franzini Andrea, Milani Davide, Attuati Luca, Navarria Pierina, Pessina Federico, Picozzi Piero
Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy.
Department of Radiation Oncology, IRCCS Humanitas Research Hospital, Milan, Italy.
Stereotact Funct Neurosurg. 2023;101(2):86-92. doi: 10.1159/000528632. Epub 2023 Feb 2.
The treatment of medically refractory patients with chronic short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is challenging. Stereotactic radiosurgery targeting the trigeminal nerve and sphenopalatine ganglion (SPG) has been used as a less-invasive treatment. The outcomes of this procedure have been described in a few case reports.
The objective of the study was to report on the effect of Gamma Knife radiosurgery (GKRS) in 5 patients with chronic SUNCT.
Retrospective review of our GKRS database identified 5 patients with chronic SUNCT who underwent GKRS targeted to the trigeminal nerve and SPG. A maximum dose of 80-85 Gy and 80 Gy was, respectively, delivered to the trigeminal nerve and SPG. Pain intensity and facial numbness were evaluated using the Barrow Neurological Institute (BNI) scores.
These 5 patients were clinically followed for a mean period of 26.2 months. Within a period ranging from 2 days to 9 months, GKRS was successful in reducing pain attacks and autonomic symptoms in all 5 patients. At the last assessments, BNI pain scores of I, II, and IIIa were achieved in 1, 1, and 3 patients, respectively. Two patients developed nonbothersome facial numbness (BNI facial numbness score II).
These 5 cases show that GKRS targeted to both the trigeminal nerve and the SPG is effective in reducing pain and autonomic symptoms of patients with SUNCT, although nonbothersome trigeminal sensory disturbances may occur.
对于药物治疗无效的慢性发作性偏侧神经痛样头痛伴结膜充血及流泪（SUNCT）患者，其治疗颇具挑战性。立体定向放射外科手术靶向三叉神经和蝶腭神经节（SPG）已被用作一种侵入性较小的治疗方法。少数病例报告描述了该手术的结果。
本研究的目的是报告伽玛刀放射外科手术（GKRS）对5例慢性SUNCT患者的疗效。
对我们的GKRS数据库进行回顾性分析，确定了5例接受针对三叉神经和SPG的GKRS治疗的慢性SUNCT患者。分别向三叉神经和SPG给予最大剂量80 - 85 Gy和80 Gy的照射。使用巴罗神经学研究所（BNI）评分评估疼痛强度和面部麻木情况。
这5例患者的临床随访平均时间为26.2个月。在2天至9个月的时间内，GKRS成功减轻了所有5例患者的疼痛发作和自主神经症状。在最后一次评估时，1例、1例和3例患者分别达到了BNI疼痛评分I、II和IIIa。2例患者出现了不困扰的面部麻木（BNI面部麻木评分II）。
这5例病例表明，尽管可能会出现不困扰的三叉神经感觉障碍，但针对三叉神经和SPG的GKRS在减轻SUNCT患者的疼痛和自主神经症状方面是有效的。
