Düzkalir Ali Haluk, Askeroglu Mehmet Orbay, Peker Selcuk
Department of Neurosurgery, Koç University Hospital, Istanbul, Turkey.
Department of Neurosurgery, Gamma Knife Center, Koç University Hospital, Istanbul, Turkey.
Neurosurg Rev. 2025 Feb 17;48(1):245. doi: 10.1007/s10143-025-03400-9.
Stereotactic radiosurgery (SRS) is a potential treatment for trigeminal neuralgia (TN) secondary to arteriovenous malformations (AVMs), though its efficacy and safety remain unclear due to the rarity of this condition. We analyzed 1211 brain AVM cases treated with Gamma Knife radiosurgery (GKRS) between 2005 and 2023 at our institution. Four patients (0.33%) were presented with TN secondary to AVM. Three patients received single-fraction GKRS while one underwent hypofractionated treatment. Treatment outcomes were assessed using magnetic resonance imaging, digital subtraction angiography, and the Barrow Neurological Institute pain intensity scale. The mean marginal dose and AVM volume were 21.5 Gy and 0.58 cc, respectively. The mean follow-up period was 85.75 months. Complete AVM obliteration was achieved in all patients, with all experiencing complete pain relief within a mean time of 18 months, enabling gradual discontinuation of medications. No radiation-related adverse effects were observed. Our literature review identified only 15 previously reported cases where SRS was used as primary treatment for TN secondary to AVM, with most cases showing favorable outcomes in pain relief and AVM obliteration. This study is the first case series to demonstrate the sole use and efficacy of GKRS in managing TN secondary to AVM, moving beyond individual case reports. SRS appears to be a safe and effective primary treatment option for TN secondary to AVM, particularly when conventional surgical approaches are contraindicated or pose excessive risks. The sustained pain relief and absence of complications in our series, combined with previous case reports, support its use in managing this rare condition.
立体定向放射外科（SRS）是治疗继发于动静脉畸形（AVM）的三叉神经痛（TN）的一种潜在方法，不过由于这种情况罕见，其疗效和安全性仍不明确。我们分析了2005年至2023年在我们机构接受伽玛刀放射外科（GKRS）治疗的1211例脑动静脉畸形病例。4例患者（0.33%）表现为继发于AVM的TN。3例患者接受单次分割GKRS治疗，1例接受低分割治疗。使用磁共振成像、数字减影血管造影和巴罗神经学研究所疼痛强度量表评估治疗结果。平均边缘剂量和AVM体积分别为21.5 Gy和0.58 cc。平均随访期为85.75个月。所有患者的AVM均实现完全闭塞，所有患者在平均18个月内疼痛完全缓解，能够逐渐停用药物。未观察到与放射相关的不良反应。我们的文献综述仅发现15例先前报道的将SRS用作继发于AVM的TN的主要治疗方法的病例，大多数病例在疼痛缓解和AVM闭塞方面显示出良好的结果。本研究是首个证明GKRS单独用于治疗继发于AVM的TN及其疗效的病例系列，超越了个别病例报告。SRS似乎是继发于AVM的TN的一种安全有效的主要治疗选择，特别是在传统手术方法禁忌或风险过高时。我们系列中持续的疼痛缓解和无并发症，结合先前的病例报告，支持将其用于治疗这种罕见疾病。
