Department of Neurosurgery, Faculty of Medicine, Gazi University, Emniyet Mahallesi, Mevlana Bulvarı No: 29, Ankara, Turkey.
Department of Neurosurgery, Sincan Training and Research Hospital, Ankara, Turkey.
Acta Neurochir (Wien). 2024 Nov 28;166(1):482. doi: 10.1007/s00701-024-06365-8.
Before commonly used targets such as the Retrogasserian Zone (RGZ) and the Root Entry Zone (REZ) were adopted for the radiosurgical treatment of trigeminal neuralgia (TN), a more anterior target involving the Gasserian ganglion was used. Thanks to advancements in imaging technology, it is now possible to identify and target separate nerve divisions in Meckel's Cave as desired. Although this approach has been mentioned previously, no clinical study has investigated it until now. This study aims to fill this gap in the literature.
Trigeminal neuralgia patients who received radiosurgical treatment between February 2019 and June 2022 in a single centre were included in the study. Pain relief, medication dependency and side effect profiles of the investigated anterior selective target (AST) were compared to those of the classical targets at 1 week, 1-3-6 months, and 1 year.
A total of 66 patients were included in the study. Effectiveness, safety and application convenience parameters were compared between; the REZ (n = 21), RGZ (n = 20) and AST (n = 25) groups. All groups showed significant improvement in pain with similar results to each other. AST treatments were performed in significantly shorter beam-on-times and with significantly lower brainstem doses.
The investigated AST showed comparable results to the classical targets without any indication of superiority or inferiority in terms of efficacy and safety in this preliminary investigation. As no blocks were needed to protect the brainstem with this method, it can be used for select patients as needed and could even be investigated in larger studies as an alternative approach.
在采用经伽玛刀治疗三叉神经痛（TN）的常用靶点（如 Retrogressarian 区（RGZ）和根进入区（REZ）之前，曾使用涉及三叉神经节的更靠前的靶点。由于成像技术的进步，现在可以根据需要识别和靶向 Meckel 氏腔中的单独神经分支。尽管这种方法以前已经提到过，但直到现在才有临床研究对其进行调查。本研究旨在填补该文献中的空白。
在单中心接受伽玛刀治疗的三叉神经痛患者被纳入研究。在 1 周、1-3-6 个月和 1 年时，比较了所研究的前选择性靶点（AST）与经典靶点的止痛效果、药物依赖性和副作用概况。
共纳入 66 例患者。在 REZ（n=21）、RGZ（n=20）和 AST（n=25）组之间比较了有效性、安全性和应用便利性参数。所有组的疼痛均有明显改善，彼此之间的结果相似。AST 治疗的束流开启时间明显更短，脑干剂量明显更低。
在这项初步研究中，所研究的 AST 与经典靶点的结果相似，在疗效和安全性方面没有优势或劣势的迹象。由于这种方法不需要进行阻滞来保护脑干，因此可以根据需要选择性地用于某些患者，甚至可以在更大的研究中作为替代方法进行研究。
