Goel Mahima, Patil Nitin U, Singh Romalpreet, John Janice, Upadhyay Bipin R
Department of Oral and Maxillofacial Surgery, Pacific Dental College and Research Centre, Udaipur, IND.
Department of Oral and Maxillofacial Surgery, Jawahar Medical Foundation's Annasaheb Chudaman Patil Memorial Dental College, Dhule, IND.
Cureus. 2023 Sep 18;15(9):e45468. doi: 10.7759/cureus.45468. eCollection 2023 Sep.
Stereotactic radiosurgery (SRS), also known as gamma knife surgery (GKS), is a noninvasive procedure for treating tic douloureux (TD) or trigeminal neuralgia (TN). Due to a lack of sufficient evidence regarding the indication of SRS for the treatment of recurrent TD, the present scoping review was conducted to assess the effectiveness of repeated SRS procedures for managing recurrent TD. The literature search was performed from January 2012 to December 2022 on the PubMed, Scopus, and Web of Science databases. Of the 215 initial results obtained, 10 articles were finally selected for the review. Three studies used the SRS procedure for the third time in patients with recurrent TD. All studies were retrospective, with a mean maximal dose of 70-90 Gy and a cumulative dose of 120-180 Gy for two SRS treatments and 150-270 Gy for three SRS treatments. The target zone for irradiation was the retrogasserian zone (RGZ). Repeat SRS procedures led to pain relief in 80-90% of patients within one to four months and excellent pain relief in 50-90% of patients. Pain recurrence was noticed after one year in 20-40% of patients. Postoperative complications, such as trigeminal nerve deficits, facial numbness, and mild corneal dryness, were noted in the studies. The review concluded that repeat SRS is an effective and relatively safe procedure for pain management in patients with recurrent TD.
立体定向放射外科手术（SRS），也称为伽玛刀手术（GKS），是一种治疗三叉神经痛（TD）或三叉神经痛（TN）的非侵入性手术。由于缺乏关于SRS治疗复发性TD适应症的充分证据，本范围综述旨在评估重复SRS手术治疗复发性TD的有效性。检索了2012年1月至2022年12月期间PubMed、Scopus和Web of Science数据库的文献。在获得的215个初始结果中，最终选择了10篇文章进行综述。三项研究在复发性TD患者中第三次使用了SRS手术。所有研究均为回顾性研究，两次SRS治疗的平均最大剂量为70-90 Gy，累积剂量为120-180 Gy，三次SRS治疗的平均最大剂量为150-270 Gy。照射的目标区域是半月神经节后区（RGZ）。重复SRS手术在1至4个月内使80-90%的患者疼痛缓解，50-90%的患者疼痛得到极佳缓解。20-40%的患者在一年后出现疼痛复发。研究中还提到了术后并发症，如三叉神经功能缺损、面部麻木和轻度角膜干燥。综述得出结论，重复SRS是治疗复发性TD患者疼痛的一种有效且相对安全的手术。
