Department of Surgery, Federal Teaching Hospital, Ido-Ekiti/Afe Babalola University, Ado-Ekiti, Nigeria.
Department of Neurosurgery and Gamma Knife Surgery, P D Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India.
Neurol India. 2023 Mar-Apr;71(Supplement):S161-S167. doi: 10.4103/0028-3886.373623.
Medical management is the first line of care for patients with trigeminal neuralgia (TN), and carbamazepine is the drug of choice used alone or in combination with other drugs. Gamma knife radiosurgery (GKRS) has been an established option in the management of refractory TN based on its noninvasiveness and robust safety profile. Our study aims to confirm the safety and assess the efficacy of GKRS in the management of TN.
A retrospective review of the patients with refractory TN treated with GKRS from 1997 to March 2019 by the senior author was carried out. Out of 194 eligible patients, detailed clinical information was not available in 41 patients. The remaining 153 patients' case files (post-GKRS cohort) were reviewed, and data obtained were collated, computed, and analyzed. An additional cross-sectional analysis was carried out telephonically in the post-GKRS cohort in January 2021 using Barrow Neurological Institute (BNI) pain scoring, to obtain the long-term efficacy of GKRS in TN.
The majority of the patients (96.1%) received a radiation dose of 80 Gy. At 6 months, 94.8% of patients had satisfactory response to GKRS. Follow-up ranged between 1 and 7.5 years. The recurrence rate was 9.2% and the complication rate was 4.6%. Facial numbness was the commonest complication. No mortality was reported. The cross-sectional arm of the study had a response rate of 39.2% (60 patients). Adequate pain relief (BNI I/II/IIIa/IIIb) was reported in 85% of patients.
GKRS is a safe and effective modality of treatment for TN without any major complications. Both short-term and long-term efficacies are excellent.
医学管理是治疗三叉神经痛（TN）患者的一线治疗方法，卡马西平是单独使用或与其他药物联合使用的首选药物。伽玛刀放射外科（GKRS）基于其非侵入性和强大的安全性，已成为治疗难治性 TN 的既定选择。我们的研究旨在确认 GKRS 在治疗 TN 中的安全性并评估其疗效。
对高级作者于 1997 年至 2019 年 3 月期间用 GKRS 治疗的难治性 TN 患者进行了回顾性研究。194 名符合条件的患者中，有 41 名患者的详细临床信息无法获得。回顾了其余 153 名患者的病例档案（GKRS 后队列），并对获得的数据进行了整理、计算和分析。在 2021 年 1 月，对 GKRS 后队列进行了额外的横断面分析，使用巴罗神经研究所（BNI）疼痛评分，以获得 GKRS 在 TN 中的长期疗效。
大多数患者（96.1%）接受了 80 Gy 的放射剂量。在 6 个月时，94.8%的患者对 GKRS 有满意的反应。随访时间在 1 至 7.5 年之间。复发率为 9.2%，并发症发生率为 4.6%。面部麻木是最常见的并发症。无死亡报告。研究的横断面部分有 60 名患者，反应率为 39.2%。85%的患者报告疼痛得到充分缓解（BNI I/II/IIIa/IIIb）。
GKRS 是治疗 TN 的一种安全有效的治疗方法，没有任何重大并发症。短期和长期疗效均极佳。
