Anterior selective targeting for radiosurgical treatment of trigeminal neuralgia: a cohort study

IF 1.9 3区 医学 Q3 CLINICAL NEUROLOGY
Alperen Sozer, Ozan Yavuz Tufek, Merve Buke Sahin, Mustafa Caglar Sahin, Ozlem Dagli, Alp Ozgun Borcek, Hakan Emmez, Gokhan Kurt, Aydemir Kale, Sukru Aykol, Mesut Emre Yaman
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Abstract

Objective

Before commonly used targets such as the Retrogasserian Zone (RGZ) and the Root Entry Zone (REZ) were adopted for the radiosurgical treatment of trigeminal neuralgia (TN), a more anterior target involving the Gasserian ganglion was used. Thanks to advancements in imaging technology, it is now possible to identify and target separate nerve divisions in Meckel’s Cave as desired. Although this approach has been mentioned previously, no clinical study has investigated it until now. This study aims to fill this gap in the literature.

Methods

Trigeminal neuralgia patients who received radiosurgical treatment between February 2019 and June 2022 in a single centre were included in the study. Pain relief, medication dependency and side effect profiles of the investigated anterior selective target (AST) were compared to those of the classical targets at 1 week, 1–3-6 months, and 1 year.

Results

A total of 66 patients were included in the study. Effectiveness, safety and application convenience parameters were compared between; the REZ (n = 21), RGZ (n = 20) and AST (n = 25) groups. All groups showed significant improvement in pain with similar results to each other. AST treatments were performed in significantly shorter beam-on-times and with significantly lower brainstem doses.

Conclusions

The investigated AST showed comparable results to the classical targets without any indication of superiority or inferiority in terms of efficacy and safety in this preliminary investigation. As no blocks were needed to protect the brainstem with this method, it can be used for select patients as needed and could even be investigated in larger studies as an alternative approach.

Abstract Image

放射外科治疗三叉神经痛的前部选择性定位:一项队列研究
目的在三叉神经痛(TN)放射外科治疗采用逆行性神经节区(RGZ)和根入区(REZ)等常用靶点之前,曾使用过涉及 Gasserian 神经节的更前端靶点。由于成像技术的进步,现在可以根据需要识别并瞄准梅克尔洞中的独立神经分支。虽然这种方法以前曾被提及,但直到现在还没有临床研究对此进行过调查。本研究旨在填补这一文献空白。研究方法将 2019 年 2 月至 2022 年 6 月期间在一个中心接受放射外科治疗的三叉神经痛患者纳入研究。将所研究的前部选择性靶点(AST)与经典靶点在 1 周、1-3-6 个月和 1 年的疼痛缓解、药物依赖和副作用情况进行比较。对 REZ 组(21 人)、RGZ 组(20 人)和 AST 组(25 人)的有效性、安全性和应用方便性参数进行了比较。所有治疗组的疼痛均有明显改善,且效果相似。结论在这项初步调查中,所研究的 AST 在疗效和安全性方面没有任何优劣迹象,显示出与传统靶点相当的效果。由于使用这种方法无需阻滞以保护脑干,因此可根据需要选择用于某些患者,甚至可作为一种替代方法在更大规模的研究中进行探讨。
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来源期刊
Acta Neurochirurgica
Acta Neurochirurgica 医学-临床神经学
CiteScore
4.40
自引率
4.20%
发文量
342
审稿时长
1 months
期刊介绍: The journal "Acta Neurochirurgica" publishes only original papers useful both to research and clinical work. Papers should deal with clinical neurosurgery - diagnosis and diagnostic techniques, operative surgery and results, postoperative treatment - or with research work in neuroscience if the underlying questions or the results are of neurosurgical interest. Reports on congresses are given in brief accounts. As official organ of the European Association of Neurosurgical Societies the journal publishes all announcements of the E.A.N.S. and reports on the activities of its member societies. Only contributions written in English will be accepted.
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