Radiosurgery for classical trigeminal neuralgia: impact of the shot size on clinical outcome

The Journal of Headache and Pain

Research

Nicolas Garnier¹  Benjamin Serrano¹  Regis Amblard¹  Rémy Villeneuve¹  Stéphane Chanalet²  Philippe Colin³  Maud le Guyader³  Cécile Ortholan⁴  Denys Fontaine⁵  Haiel Alchaar⁶  Thibault Bouet⁶  Eric Bozzolo⁷  Michel Lanteri-Minet⁸ 

[1] Department of Medical Physics, Centre Hospitalier Princesse Grace, Monaco, Monaco;Department of Radiology, Centre Hospitalier Princesse Grace, Monaco, Monaco;Department of Radiology, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, Nice, France;Department of Radiotherapy, Centre Hospitalier Princesse Grace, Monaco, Monaco;Department of Radiotherapy, Centre Hospitalier Princesse Grace, Monaco, Monaco;Department of Radiation Oncology, Centre Hospitalier Princesse Grace, 98000, Monaco, Monaco;FHU Inovpain, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, Nice, France;Department of Neurosurgery, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, Nice, France;Pain Clinic, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, Nice, France;Pain Clinic, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, Nice, France;FHU Inovpain, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, Nice, France;Pain Clinic, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, Nice, France;FHU Inovpain, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, Nice, France;INSERM/UdA, U1107, Neuro-Dol, Trigeminal Pain and Migraine, University Clermont-Auvergne, Clermont-Ferrand, France;

关键词: Trigeminal neuralgia;    Radiosurgery;    Shot size;    Linear accelerator;    Pain;   

DOI  :  10.1186/s10194-023-01583-4

 received in 2023-03-09, accepted in 2023-04-21,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThis study compares the outcome of patients suffering from medically refractory classical trigeminal neuralgia (TN) after treatment with radiosurgery using two different shot sizes (5- and 6-mm).MethodsAll patients included in this open, prospective, non-controlled study were treated in a single institution for TN (95 cases in 93 patients) with LINear ACcelerators (LINAC) single-dose radiosurgery using a 5-mm shot (43 cases) or 6-mm shot (52 cases). The target was positioned on the intracisternal part of the trigeminal nerve.ResultsThe mean Dmax (D0.035) to the brainstem was higher in the 6-mm group: 12.6 vs 21.3 Gy (p < 0.001). Pain relief was significantly better in the 6-mm group: at 12 and 24 months in the 6-mm group the rate of pain-free patients was 90.2 and 87.8%, respectively vs. 73.6 and 73.6% in the 5-mm group (p = 0.045). At 12 and 24 months post-radiosurgical hypoesthesia was more frequent in the 6-mm group: 47.0 and 58% vs.11.3 and 30.8% in the 5-mm group (p = 0.002). To investigate the effect of cone diameter and the dose to the brainstem on outcomes, patients were stratified into three groups: group 1 = 5-mm shot, (all Dmax < 25 Gy, 43 cases), group 2 = 6-mm shot, Dmax < 25 Gy (32 cases), group 3 = 6-mm shot Dmax > 25 Gy (20 cases). At 12 months the rates of hypoesthesia were 11.3, 33.5 and 76.0%, respectively in groups 1, 2 and 3 (p < 0.001) and the rates of recurrence of pain were 26.4, 16.5 and 5%, respectively, (p = 0.11).ConclusionLINAC treatment with a 6-mm shot provided excellent control of pain, but increased the rate of trigeminal nerve dysfunction, especially when the maximum dose to the brainstem was higher than 25 Gy.

【 授权许可】

CC BY   
© The Author(s) 2023

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