Shields Lisa B E, Malkawi Azzam, Daniels Michael W, Rao Abigail J, Plato Brian M, Yao Tom L, Howe Jonathan N, Spalding Aaron C
Norton Healthcare, Norton Neuroscience Institute, Louisville, Kentucky, United States.
Norton Neuroscience Institute, Norton Healthcare, Norton Cancer Institute, Louisville, Kentucky, United States.
Surg Neurol Int. 2024 May 31;15:181. doi: 10.25259/SNI_101_2024. eCollection 2024.
Frameless image-guided radiosurgery (IGRS) is an effective and non-invasive method of treating patients who are unresponsive to medical management for trigeminal neuralgia (TN). This study evaluated the use of frameless IGRS to treat patients with medically refractory TN.
We performed a retrospective review of records of 116 patients diagnosed with TN who underwent frameless IGRS using a linear accelerator (LINAC) over 10 years (March 2012-February 2023). All patients had failed medical management for TN. Facial pain was graded using the Barrow Neurological Institute (BNI) scoring system. Each patient received a BNI score before frameless IGRS and following treatment. Failure was defined as a BNI score IV-V at the last follow-up and/or undergoing a salvage procedure following IGRS.
All patients had a BNI score of either IV or V before the frameless IGRS. The mean follow-up duration for all 116 patients following IGRS was 44.1 months. Most patients (81 [69.8%]) had not undergone surgery (microvascular decompression [MVD] or rhizotomy) or stereotactic radiosurgery (SRS) for TN before frameless IGRS. A total of 41 (35.3%) patients underwent a salvage procedure (MVD, rhizotomy, or an additional IGRS) following frameless IGRS. The mean duration between the initial frameless IGRS and salvage procedure was 20.1 months. At the last follow-up, a total of 110 (94.8%) patients had a BNI score of I-III. No complications were reported after the frameless IGRS. The BNI score at the last follow-up was lower compared to the initial BNI for patients regardless of prior intervention ( < 0.001). Patients who failed IGRS had a higher BNI score at the last follow-up compared to those who did not fail IGRS (2.8 vs. 2.5, = 0.05). Patients with pain relief had a shorter follow-up compared to those with pain refractory to SRS (38.0 vs. 55.1, = 0.005).
In this large cohort of patients with medically refractory TN, frameless IGRS resulted in durable pain control in the majority of patients without any toxicity.
无框架影像引导放射外科（IGRS）是治疗三叉神经痛（TN）药物治疗无效患者的一种有效且非侵入性的方法。本研究评估了无框架IGRS治疗药物难治性TN患者的应用情况。
我们对116例诊断为TN的患者的记录进行了回顾性分析，这些患者在10年期间（2012年3月至2023年2月）使用直线加速器（LINAC）接受了无框架IGRS治疗。所有患者的TN药物治疗均失败。使用巴罗神经学研究所（BNI）评分系统对面部疼痛进行分级。每位患者在无框架IGRS治疗前和治疗后均接受BNI评分。失败定义为最后一次随访时BNI评分为IV - V级和/或在IGRS治疗后接受挽救手术。
所有患者在无框架IGRS治疗前的BNI评分均为IV级或V级。116例患者IGRS治疗后的平均随访时间为44.1个月。大多数患者（81例[69.8%]）在无框架IGRS治疗前未因TN接受过手术（微血管减压术[MVD]或神经根切断术）或立体定向放射外科（SRS）治疗。共有41例（35.3%）患者在无框架IGRS治疗后接受了挽救手术（MVD、神经根切断术或再次IGRS治疗）。首次无框架IGRS治疗与挽救手术之间的平均间隔时间为20.1个月。在最后一次随访时，共有110例（94.8%）患者的BNI评分为I - III级。无框架IGRS治疗后未报告并发症。无论先前是否接受过干预，患者最后一次随访时的BNI评分均低于初始BNI评分（<0.001）。与未失败的IGRS患者相比，IGRS治疗失败的患者在最后一次随访时的BNI评分更高（2.8对2.5，P = 0.05）。疼痛缓解的患者与SRS治疗难治性疼痛的患者相比，随访时间更短（38.0对55.1，P = 0.00５）。
在这一大群药物难治性TN患者中，无框架IGRS使大多数患者实现了持久的疼痛控制，且无任何毒性。
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