Monica Lara-Almunia, Nuria E Martinez Moreno, Cristina V Torres Diaz, Jorge Gutierrez Sarraga, Roberto Martinez Alvarez
{"title":"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。","authors":"Monica Lara-Almunia, Nuria E Martinez Moreno, Cristina V Torres Diaz, Jorge Gutierrez Sarraga, Roberto Martinez Alvarez","doi":"10.1016/j.wneu.2024.11.028","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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%.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123445"},"PeriodicalIF":1.9000,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Gamma Knife Radiosurgery, Central Lateral Thalamotomy, and Chronic Neuropathic Pain: A Prospective Single-Center Study With Long-Term Follow-Up.\",\"authors\":\"Monica Lara-Almunia, Nuria E Martinez Moreno, Cristina V Torres Diaz, Jorge Gutierrez Sarraga, Roberto Martinez Alvarez\",\"doi\":\"10.1016/j.wneu.2024.11.028\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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%.</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":23906,\"journal\":{\"name\":\"World neurosurgery\",\"volume\":\" \",\"pages\":\"123445\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2024-12-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"World neurosurgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.wneu.2024.11.028\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"World neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.wneu.2024.11.028","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Gamma Knife Radiosurgery, Central Lateral Thalamotomy, and Chronic Neuropathic Pain: A Prospective Single-Center Study With Long-Term Follow-Up.
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.
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
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