Gamma Knife Radiosurgery, Central Lateral Thalamotomy, and Chronic Neuropathic Pain: A Prospective Single-Center Study With Long-Term Follow-Up.

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery Pub Date : 2024-12-09 DOI:10.1016/j.wneu.2024.11.028

Monica Lara-Almunia, Nuria E Martinez Moreno, Cristina V Torres Diaz, Jorge Gutierrez Sarraga, Roberto Martinez Alvarez

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Abstract

Objective: We present our experience in using Gamma knife surgery (GKS) on the posterior part of the central lateral nucleus (CLp) for refractory neuropathic pain, examining its long-term efficacy and safety in patients with one of the longest pretreatment pain duration in the literature. Furthermore, we examined certain factors that might influence the outcome of this technique.

Methods: We conducted a prospective study involving 9 patients who underwent GKS between 2020 and 2023. We employed Icon model GKS and Vantage stereotactic frame. The planning process encompassed a dual localization system. The assessments involved the use of both the visual analog and Barrow Neurological Institute (BNI) scales (6 months, 12 months, and then annually). Data analysis was developed using SPSS 25.

Results: Our series consisted of 6 women and 3 men with an average age of 52.3 ± 17.4 years. A maximum dose of 130 Gy was administered. The mid-term postoperative period (1 year) showed that 8 patients (88.9%) experienced significant pain relief (visual analog scale P = 0.011; BNI IIIa). The median follow-up time was 24.8 ± 8.2. At the last assessment, all patients maintained their improvement (visual analog scale P = 0.018; BNI IIIa). We found no association between patient age (P = 0.329), duration of pretreatment pain (P = 0.469), multiple previous surgical treatments (P = 0.750) or the pain's etiology (P = 0.25), and poorer outcomes post CLp thalamotomy. None of the cases has experienced a recurrence so far. Both morbidity and mortality were 0%.

Conclusions: Our findings suggest that bilateral ablation of the CLp using GKS is both effective and safe for treating drug-resistant neuropathic pain. This simple, accurate, and noninvasive surgical technique effectively achieves pain control across various localized areas and sustains a lasting clinical response, even in patients with multiple previous surgical interventions or prolonged pain duration.

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伽玛刀放射外科手术、中央外侧丘脑切开术与慢性神经病理性疼痛。一项长期随访的前瞻性单中心研究。

目的：神经性疼痛约占总人口的 7-10%。随着年龄的增长，患上神经性疼痛的风险也会增加，而且任何性别的人都可能受到影响。治疗神经性疼痛通常需要采取多种策略。药物治疗无效并出现慢性症状的患者可考虑手术治疗。中外侧核（CLp）的后部是治疗这类病例的一个很有前景的靶点。我们介绍了在中枢外侧核后部（CLp）使用伽玛刀手术（GKS）治疗难治性神经病理性疼痛的经验，并对文献中治疗前疼痛持续时间最长的患者的长期疗效和安全性进行了研究。此外，我们还研究了可能影响该技术效果的某些因素：我们进行了一项前瞻性研究，共有 9 名患者在 2020 年至 2023 年期间接受了伽马手术。我们使用了 Icon 型伽玛刀和 Vantage 型立体定向框架。计划过程包括双定位系统。评估采用视觉模拟量表（VAS）和巴罗神经研究所（BNI）量表（6个月、12个月，然后每年一次）。数据分析使用 SPSS25 进行：术后中期（1 年）显示，8 名患者（88.9%）疼痛明显缓解（VAS p=0.011；BNI I-IIIa），随访时间中位数为 24.8±8.2（12-37 个月）。我们发现患者年龄（P=0.329）、治疗前疼痛持续时间（P=0.469）、既往多次手术治疗（P=0.750）或疼痛病因（P=0.25）与 CLp 丘脑切除术后较差的疗效之间没有关联：我们的研究结果表明，使用 GKS 对 CLp 进行双侧消融治疗耐药神经病理性疼痛既有效又安全。这种简单、准确和无创的手术技术可有效控制不同局部区域的疼痛，并维持持久的临床反应，即使是既往接受过多次手术干预或疼痛持续时间较长的患者也不例外。这些研究结果鼓励我们将这种技术视为对这些患者非常有益的策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

World neurosurgery CLINICAL NEUROLOGY-SURGERY

CiteScore

3.90

自引率

15.00%

发文量

1765

审稿时长

47 days

期刊介绍： World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS