Stereotactic radiosurgery in treatment of trigeminal neuralgia

A. V. Bervitskiy; G. I. Moysak; I. S. Zubatkina; P. I. Ivanov; D. A. Rzaev; E. V. Amelina

doi:10.17116/neiro20198302137

Stereotactic radiosurgery in treatment of trigeminal neuralgia

Переведенное название: Стереотаксическая радиохирургия в лечении тригеминальной невралгии

A. V. Bervitskiy, G. I. Moysak, I. S. Zubatkina, P. I. Ivanov, D. A. Rzaev, E. V. Amelina

Кафедра нейронаук ИМПЗ

Результат исследования: Научные публикации в периодических изданиях › статья › рецензирование

Аннотация

Стереотаксическая радиохирургия (СРХ) для лечения тригеминальной невралгии (ТН) стала применяться относительно недавно. Будучи малоинвазивным, метод может рассматриваться как альтернатива прямым хирургическим вмешательствам. Цель исследования - проанализировать результаты лечения пациентов с ТН методом стереотаксической радиохирургии на аппарате Leksell Gamma Knife. Материал и методы. Проанализированы результаты лечения 52 больных (31 женщина и 21 мужчина в возрасте от 31 до 79 лет), оперированных методом СРХ в 2009-2016 гг. в радиохирургическом центре МИБС (Санкт-Петербург). У 44 пациентов диагностирована типичная ТН (1-го типа), у 4 - атипичная (2-го типа) и у 4 - симптоматическая невралгия (при рассеянном склерозе). Оценка выраженности боли проводилась с помощью визуальной аналоговой шкалы (ВАШ) и шкалы Неврологического института Barrow (BNIPS) до и после операции и в катамнезе (средняя длительность катамнеза 3 года). Результаты. Уменьшение болевого синдрома отмечено у 38 (86,4%) пациентов с невралгией 1-го типа. При этом эффект, как правило, наступал не сразу после операции, а в сроки от нескольких недель до 12 мес (2 - медиана, интерквартильный размах) [1, 4]. У 6 (14%) больных с невралгией 1-го типа операция была неэффективной. У 8 (18%) больных отмечен рецидив - в среднем через 2 года и 5 мес. В целом у 22 (50%) больных удалось достичь I градации боли по BNIPS, у 7 (16%) - II-III градации. При невралгии 2-го типа первичного снижения боли удалось достичь у 2 больных, у одного из них спустя 19 мес развился рецидив. У больных с симптоматической невралгией радиохирургия была эффективна в 3 случаях, но у 2 из них наступил рецидив. Выводы. Радиохирургия способна купировать болевой синдром у большинства больных с ТН 1-го типа, однако по результатам она уступает инвазивным вмешательствам. По нашим данным, у 18% больных возникает рецидив. У больных с ТН 2-го типа и симптоматической невралгией при рассеянном склерозе метод не обладает достаточной эффективностью. В случаях, когда возможен выбор между радиохирургией и микроваскулярной декомпрессией при ТН 1-го и 2-го типа, определяющее значение имеет выбор пациента, при этом важно информировать его не только о возможных осложнениях вмешательства, но и об отложенном эффекте операции и частоте рецидивов

Переведенное название	Стереотаксическая радиохирургия в лечении тригеминальной невралгии
Язык оригинала	английский
Страницы (с-по)	37-48
Число страниц	12
Журнал	Zhurnal Voprosy Nejrokhirurgii Imeni N.N. Burdenko
Том	83
Номер выпуска	2
DOI	https://doi.org/10.17116/neiro20198302137
Состояние	Опубликовано - 1 янв 2019

Ключевые слова

Adult
Aged
Female
Follow-Up Studies
Humans
Male
Middle Aged
Pain Measurement
Radiosurgery
Treatment Outcome
Trigeminal Neuralgia/radiotherapy

ГРНТИ

76 МЕДИЦИНА И ЗДРАВООХРАНЕНИЕ

Доступ к документу

10.17116/neiro20198302137

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@article{fc6516e47c204d439c80f007ceeebd1e,

title = "Stereotactic radiosurgery in treatment of trigeminal neuralgia",

abstract = "It was not until relatively recently that the method of stereotactic radiosurgery has started to be used for treating trigeminal neuralgia. Being minimally invasive, this method can be considered an attractive alternative to invasive surgical methods. Objective — the objective of this study was to analyze the results of treatment in patients with trigeminal neuralgia using the Leksell Gamma Knife system. Material and methods. The results of stereotactic radiosurgery were analyzed in 52 patients (31 females and 21 males aged 31 to 79 years) who had undergone treatment at the Radiosurgical Center of MIBS (St. Petersburg) in 2009—2016. Forty-four patients were diagnosed with typical trigeminal neuralgia; four patients, with atypical neuralgia; and four patients, with symptomatic neuralgia (accompanying multiple sclerosis). Pain severity was assessed using the Visual Analogue Scale (VAS) and the Barrow Neurological Institute Scale (BNIPS) before and after the surgery, as well as during the follow-up period (mean duration, 3 years). Results. Pain was reduced in 38 (86.4%) patients with type 1 neuralgia. The effect usually was not observed immediately after the surgery but was delayed from several weeks to 12 months (median, 2 months; interquartile range) [1, 4]. The surgery was ineffective in 6 (14%) patients. Eight (18%) patients had a relapse on average after 2 years and 5 months. By the end of the follow-up period, score I according to the BNIPS was achieved in 22 (50%) patients; score II or III was achieved in 7 (16%) patients. Primary reduction of pain was achieved in two patients with type 2 neuralgia; one of them had a relapse after 19 months. Among patients with symptomatic neuralgia, the primary effect was achieved in three patients, but two of them later had a relapse. Conclusion. Stereotactic radiosurgery can be used to alleviate pain in most patients with type 1 trigeminal neuralgia, but its results are inferior to those of invasive interventions. According to our findings, 18% of patients had a relapse. For patients with multiple sclerosis accompanied by type 2 and symptomatic trigeminal neuralgia, this method is not sufficiently effective. When both microvascular decompression and stereotactic radiosurgery can be used to treat for type 1 and 2 trigeminal neuralgia, patient{\textquoteright}s choice is crucial. It is important to inform the patient both about the potential complications of the interventions and about the delayed effect of the surgery and relapse frequency.",

keywords = "Gamma knife, Stereotactic radiosurgery, Trigeminal neuralgia, Adult, Aged, Female, Follow-Up Studies, Humans, Male, Middle Aged, Pain Measurement, Radiosurgery, Treatment Outcome, Trigeminal Neuralgia/radiotherapy",

author = "Bervitskiy, {A. V.} and Moysak, {G. I.} and Zubatkina, {I. S.} and Ivanov, {P. I.} and Rzaev, {D. A.} and Amelina, {E. V.}",

year = "2019",

month = jan,

day = "1",

doi = "10.17116/neiro20198302137",

language = "English",

volume = "83",

pages = "37--48",

journal = "Zhurnal Voprosy Neirokhirurgii Imeni N.N. Burdenko",

issn = "0042-8817",

publisher = "Media Sphera Publishing House",

number = "2",

}

Stereotactic radiosurgery in treatment of trigeminal neuralgia. / Bervitskiy, A. V.; Moysak, G. I.; Zubatkina, I. S.; Ivanov, P. I.; Rzaev, D. A.; Amelina, E. V.

В: Zhurnal Voprosy Nejrokhirurgii Imeni N.N. Burdenko, Том 83, № 2, 01.01.2019, стр. 37-48.

Результат исследования: Научные публикации в периодических изданиях › статья › рецензирование

TY - JOUR

T1 - Stereotactic radiosurgery in treatment of trigeminal neuralgia

AU - Bervitskiy, A. V.

AU - Moysak, G. I.

AU - Zubatkina, I. S.

AU - Ivanov, P. I.

AU - Rzaev, D. A.

AU - Amelina, E. V.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - It was not until relatively recently that the method of stereotactic radiosurgery has started to be used for treating trigeminal neuralgia. Being minimally invasive, this method can be considered an attractive alternative to invasive surgical methods. Objective — the objective of this study was to analyze the results of treatment in patients with trigeminal neuralgia using the Leksell Gamma Knife system. Material and methods. The results of stereotactic radiosurgery were analyzed in 52 patients (31 females and 21 males aged 31 to 79 years) who had undergone treatment at the Radiosurgical Center of MIBS (St. Petersburg) in 2009—2016. Forty-four patients were diagnosed with typical trigeminal neuralgia; four patients, with atypical neuralgia; and four patients, with symptomatic neuralgia (accompanying multiple sclerosis). Pain severity was assessed using the Visual Analogue Scale (VAS) and the Barrow Neurological Institute Scale (BNIPS) before and after the surgery, as well as during the follow-up period (mean duration, 3 years). Results. Pain was reduced in 38 (86.4%) patients with type 1 neuralgia. The effect usually was not observed immediately after the surgery but was delayed from several weeks to 12 months (median, 2 months; interquartile range) [1, 4]. The surgery was ineffective in 6 (14%) patients. Eight (18%) patients had a relapse on average after 2 years and 5 months. By the end of the follow-up period, score I according to the BNIPS was achieved in 22 (50%) patients; score II or III was achieved in 7 (16%) patients. Primary reduction of pain was achieved in two patients with type 2 neuralgia; one of them had a relapse after 19 months. Among patients with symptomatic neuralgia, the primary effect was achieved in three patients, but two of them later had a relapse. Conclusion. Stereotactic radiosurgery can be used to alleviate pain in most patients with type 1 trigeminal neuralgia, but its results are inferior to those of invasive interventions. According to our findings, 18% of patients had a relapse. For patients with multiple sclerosis accompanied by type 2 and symptomatic trigeminal neuralgia, this method is not sufficiently effective. When both microvascular decompression and stereotactic radiosurgery can be used to treat for type 1 and 2 trigeminal neuralgia, patient’s choice is crucial. It is important to inform the patient both about the potential complications of the interventions and about the delayed effect of the surgery and relapse frequency.

AB - It was not until relatively recently that the method of stereotactic radiosurgery has started to be used for treating trigeminal neuralgia. Being minimally invasive, this method can be considered an attractive alternative to invasive surgical methods. Objective — the objective of this study was to analyze the results of treatment in patients with trigeminal neuralgia using the Leksell Gamma Knife system. Material and methods. The results of stereotactic radiosurgery were analyzed in 52 patients (31 females and 21 males aged 31 to 79 years) who had undergone treatment at the Radiosurgical Center of MIBS (St. Petersburg) in 2009—2016. Forty-four patients were diagnosed with typical trigeminal neuralgia; four patients, with atypical neuralgia; and four patients, with symptomatic neuralgia (accompanying multiple sclerosis). Pain severity was assessed using the Visual Analogue Scale (VAS) and the Barrow Neurological Institute Scale (BNIPS) before and after the surgery, as well as during the follow-up period (mean duration, 3 years). Results. Pain was reduced in 38 (86.4%) patients with type 1 neuralgia. The effect usually was not observed immediately after the surgery but was delayed from several weeks to 12 months (median, 2 months; interquartile range) [1, 4]. The surgery was ineffective in 6 (14%) patients. Eight (18%) patients had a relapse on average after 2 years and 5 months. By the end of the follow-up period, score I according to the BNIPS was achieved in 22 (50%) patients; score II or III was achieved in 7 (16%) patients. Primary reduction of pain was achieved in two patients with type 2 neuralgia; one of them had a relapse after 19 months. Among patients with symptomatic neuralgia, the primary effect was achieved in three patients, but two of them later had a relapse. Conclusion. Stereotactic radiosurgery can be used to alleviate pain in most patients with type 1 trigeminal neuralgia, but its results are inferior to those of invasive interventions. According to our findings, 18% of patients had a relapse. For patients with multiple sclerosis accompanied by type 2 and symptomatic trigeminal neuralgia, this method is not sufficiently effective. When both microvascular decompression and stereotactic radiosurgery can be used to treat for type 1 and 2 trigeminal neuralgia, patient’s choice is crucial. It is important to inform the patient both about the potential complications of the interventions and about the delayed effect of the surgery and relapse frequency.

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KW - Stereotactic radiosurgery

KW - Trigeminal neuralgia

KW - Adult

KW - Aged

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Male

KW - Middle Aged

KW - Pain Measurement

KW - Radiosurgery

KW - Treatment Outcome

KW - Trigeminal Neuralgia/radiotherapy

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