Leal-Isaza Juan Pablo, Molina-Romero Oscar Iván, Diez-Palma Juan Carlos, Fonnegra-Caballero Andrés, Hernández Andrés Segura, Ramirez-Melo Laura Daniela, Fonnegra-Pardo Julio Roberto
Department of Neurosurgery, Fundación Clínica Shaio, Colombia.
Neurosurgery Program, Universidad El Bosque, Bogotá, Colombia.
Surg Neurol Int. 2024 Nov 8;15:403. doi: 10.25259/SNI_562_2024. eCollection 2024.
In the setting of refractory neuralgia or other complex facial pains, the intensity of the pain does not decrease despite medical and even surgical interventions. This report aims to describe the experience of an institution in the management of refractory trigeminal neuralgia and other complex facial pains with Gamma Knife radiosurgery (GKR), including thalamotomy as a multitarget strategy.
We conducted a retrospective observational study. Data were obtained from 50 patients with complex trigeminal neuralgia treated with GKR, in whom the thalamus was included as a target. The Visual Analog Scale (VAS) and the Barrow Neurological Institute (BNI) scale were considered before treatment and at the follow-up. The Wilcoxon test was used to compare the VAS scores and the McNemar test for the BNI scale.
The mean age was 62.7 years (standard deviation = 16.3). The indications for management with thalamotomy were neuralgia refractory to medical management (68%), recurrent pain after previous rhizolysis with GKR (20%), atypical deafferentation-type pain in patients with radiofrequency background (10%), and anatomical deformation of the trigeminal nerve by a tumor (2%). Before treatment, all patients were classified as BNI V. At follow-up, a satisfactory response to treatment was described in 82.05% of cases ( = 0.001 McNemar). The median preoperative pain evaluated with VAS was 10 (interquartile range [IQR] = 10-10), while at follow-up, it was 6 (IQR = 1-7) ( = 0.001 Wilcoxon).
The thalamus is a versatile, effective, and safe therapeutic target for ablative management in patients with complex facial pain.
在难治性神经痛或其他复杂性面部疼痛的情况下，尽管进行了药物治疗甚至手术干预，疼痛强度仍未降低。本报告旨在描述一家机构使用伽玛刀放射外科手术（GKR）治疗难治性三叉神经痛和其他复杂性面部疼痛的经验，包括将丘脑切开术作为一种多靶点策略。
我们进行了一项回顾性观察研究。数据来自50例接受GKR治疗的复杂性三叉神经痛患者，其中将丘脑作为靶点。在治疗前和随访时考虑视觉模拟量表（VAS）和巴罗神经学研究所（BNI）量表。使用Wilcoxon检验比较VAS评分，使用McNemar检验比较BNI量表。
平均年龄为62.7岁（标准差=16.3）。丘脑切开术治疗的适应证为难治性药物治疗的神经痛（68%）、先前GKR神经根切断术后复发性疼痛（20%）、有射频治疗史患者的非典型去传入性疼痛（10%）以及肿瘤导致的三叉神经解剖变形（2%）。治疗前，所有患者均被分类为BNI V级。随访时，82.05%的病例对治疗有满意反应（McNemar检验，P=0.001）。术前VAS评估的中位疼痛为10（四分位间距[IQR]=10-10），而随访时为6（IQR=1-7）（Wilcoxon检验，P=0.001）。
丘脑是复杂性面部疼痛患者进行消融治疗的一个通用、有效且安全的治疗靶点。
