Sallabanda Morena, Sallabanda Kita
Radiation Oncology, Institute of Advanced Radiosurgery (IRCA), Madrid, ESP.
Neurosurgery, Institute of Advanced Radiosurgery (IRCA), Madrid, ESP.
Cureus. 2025 Mar 22;17(3):e81011. doi: 10.7759/cureus.81011. eCollection 2025 Mar.
Radiosurgical treatment of trigeminal neuralgia (TN) is the most common functional radiosurgery procedure used to modulate refractory pain. The aim of this study is to describe the clinical results and dosimetric parameters of the first series of patients with TN treated with ZAP-X gyroscopic frameless radiosurgery (ZAP Surgical Systems, Inc., San Carlos, CA), an innovative, frameless radiosurgical device.
A total of 30 patients with TN received gyroscopic frameless radiosurgery (GRS) between February 2023 and January 2025. Treatment plans were developed delivering a maximum dose of 90 Gy in a target that covered a 5-mm segment of the trigeminal nerve in the retrogasserian location using a single isocenter (5 mm collimator). Clinical and treatment information were analyzed with a specific focus on demographic characteristics, etiology, previous treatments, Barrow Institute (BNI) Pain Intensity Scale before and after GRS (pain relief response), the time to pain relief, and the rate of complications and recurrences.
30 patients (21 females and 9 males) with a median age of 66 years (range: 31-92 years) underwent GRS for refractory TN. The median time from first diagnosis to GRS was 4 years (range: 6 months to 18 years). All patients had received a first therapeutic pharmacological line, 15 patients received at least a radiofrequency thermocoagulation, 7 patients received nerve blocks, 4 patients were treated with botox injection and 2 patients had previous radiosurgery. The median BNI Pain Intensity Scale before GRS was IV (range IIIa-V). The median treatment time was 37 minutes using a median of 221 beams. Median V12 and V10 of the brainstem were 0.04cc (range: 0-0.16cc) and 0.07cc (range: 0-0.24cc), respectively. The median BNI Pain Intensity Scale after GRS was II (range: I-VI) with 80% of patients reporting no pain or occasional pain without medication. The median time to pain relief was 15 days (range: 1-60 days). Five patients (16.6%) presented ipsilateral facial hypesthesia after GRS. 10% of patients presented with recurrent pain 2-6 months after GRS.
GRS is a precise tool for treating TN, demonstrating safety and effectiveness in what is, to our knowledge, the first reported case series documenting its use.
三叉神经痛（TN）的放射外科治疗是用于调节难治性疼痛的最常见的功能性放射外科手术。本研究的目的是描述首例采用ZAP-X无框架陀螺放射外科手术（ZAP Surgical Systems公司，加利福尼亚州圣卡洛斯）治疗的TN患者的临床结果和剂量学参数，这是一种创新的无框架放射外科设备。
2023年2月至2025年1月期间，共有30例TN患者接受了无框架陀螺放射外科手术（GRS）。制定治疗计划，使用单个等中心（5毫米准直器）在半月节后位置覆盖三叉神经5毫米节段的靶区内给予最大剂量90 Gy。对临床和治疗信息进行了分析，特别关注人口统计学特征、病因、既往治疗、GRS前后的巴罗研究所（BNI）疼痛强度量表（疼痛缓解反应）、疼痛缓解时间以及并发症和复发率。
30例患者（21例女性和9例男性）接受了GRS治疗难治性TN，中位年龄为66岁（范围：31 - 92岁）。从首次诊断到GRS的中位时间为4年（范围：6个月至18年）。所有患者均接受过一线药物治疗，15例患者至少接受过一次射频热凝治疗，7例患者接受过神经阻滞，4例患者接受过肉毒杆菌毒素注射治疗，2例患者既往接受过放射外科手术。GRS前BNI疼痛强度量表的中位数为IV级（范围IIIa - V级）。中位治疗时间为37分钟，使用的中位射束数为221束。脑干的中位V12和V10分别为0.04cc（范围：0 - 0.16cc）和0.07cc（范围：0 - 0.24cc）。GRS后BNI疼痛强度量表的中位数为II级（范围：I - VI级），80%的患者报告无疼痛或无需药物治疗的偶尔疼痛。疼痛缓解的中位时间为15天（范围：1 - 60天）。5例患者（16.6%）在GRS后出现同侧面部感觉减退。10%的患者在GRS后2 - 6个月出现复发性疼痛。
GRS是治疗TN的一种精确工具，在我们所知的首个记录其使用情况的病例系列中证明了安全性和有效性。
