[Gamma Knife radiosurgery treatment of trigeminal neuralgia and atypical facial pain]. / Tratamiento mediante radiocirugía con Gamma Knife de la neuralgia del trigémino y del dolor facial atípico.

INTRODUCTION: Typical trigeminal neuralgia (TTN) is a condition that is treated initially by pharmacological means and, if this fails, with different surgical techniques. With the advent of radiosurgery a relatively bloodless form of treatment with low toxicity and good results has become available and can be considered for use as the first choice procedure. AIMS: Our aim was to report the findings obtained from treating this pathology using Gamma Knife radiosurgery in order to assess the possibility of using it for patients with neuralgia associated to multiple sclerosis (MS) or who have atypical facial pain (AFP). We also assessed the patients who were re-treated owing to recurrence or persistence. PATIENTS AND METHODS: The sample was made up of 74 patients, including seven cases of lesions in the brain stem at the nerve entry point, 45 cases of associated vascular compression, 15 cases of AFP and eight cases of re-treatment. The median maximum dose was 84 Gy (60.2-120). The mean follow-up time was 23.26 months (1-97.83). RESULTS: Of those with TTN, 76.2% of subjects had no pain at the end of the study (75% in cases of second treatments, 69% in cases of associated vascular compression, 52% of those with prior interventions and 43% with MS), and 33% in the case of AFP. The mean time elapsed before pain disappeared was 4.34 months (0-23.72). Sensitivity was newly affected in 20.3% of patients with TTN or AFP. CONCLUSIONS: Gamma Knife radiosurgery is a first choice therapeutic option for use with patients who have TTN or AFP, as well as in cases of neuralgia associated to MS. It can also be considered for use as re-treatment with a tolerable rate of morbidity.

Tratamiento mediante radiocirugía con Gamma Knife de la neuralgia del trigémino y del dolor facial atípico / Gamma knife® radiosurgery treatment of trigeminal neuralgia and atypical facial pain

Introducción. La neuralgia típica del trigémino (NTT) es una patología tratada en primera instancia farmacológicamente y,si esto fracasa, con distintas técnicas quirúrgicas. Con la llegada de la radiocirugía, se puede optar por un tratamiento poco cruento con escasa toxicidad y buenos resultados que puede plantearse como primera alternativa. Objetivo. Presentar los resultados obtenidos al tratar esta patología mediante radiocirugía con Gamma nife de manera que se valore su posible uso también para pacientes con neuralgia asociada a esclerosis múltiple (EM) o afectos de dolor facial atípico (DFA). También evaluamos a los pacientes retratados por recidiva o persistencia. Pacientes y métodos. 74 pacientes, incluidos siete casos con lesiones en el tronco cerebral en la entrada del nervio, 45 compresiones vasculares asociadas, 15 casos de DFA y ocho retratamientos. La dosis máxima media ha resultado84 Gy (60,2-120). El seguimiento medio ha sido de 23,26meses (1-97,83). Resultados. En la NTT, un 76,2% no presentaba dolor al cierre del estudio (un 75% en segundos tratamientos, un 69%en casos de compresión vascular asociada, un 52% con intervenciones previas y un 43% con EM) y 33% en casos de DFA. El tiempo medio para la desaparición del dolor fue de 4,34 meses (0-23,72).Hay nuevas alteraciones de la sensibilidad en el 20,3% de pacientes con NTT o DFA. Conclusiones. La radiocirugía con Gamma Knife representa una alternativa como primera opción de tratamiento en pacientes con NTT y DFA, así como en la neuralgia asociada a EM. Incluso puede plantearse como retratamiento con tolerable morbilidad (AU)

Introduction. Typical trigeminal neuralgia (TTN) is a condition that is treated initially by pharmacological means and, if this fails, with different surgical techniques. With the advent of radiosurgery a relatively bloodless form of treatment with low toxicity and good results has become available and can be considered for use as the first choice procedure. Aims. Our aim was to report the findings obtained from treating this pathology using Gamma Knife radiosurgery in order to assess the possibility of using it for patients with neuralgia associated to multiple sclerosis (MS) or who have atypical facial pain (AFP).We also assessed the patients who were re-treated owing to recurrence or persistence. Patients and methods. The sample was made up of 74 patients, including seven cases of lesions in the brain stem at the nerve entry point, 45 cases of associated vascular compression, 15 cases of AFP and eight cases of re-treatment. The median maximum dose was 84 Gy (60.2-120). The mean follow-up time was 23.26 months (1-97.83). Results. Of those with TTN, 76.2% of subjects had no pain at the end of the study (75% in cases of second treatments, 69% in cases of associated vascular compression, 52% of those with prior interventions and 43% with MS), and 33% in the case of AFP. The mean time elapsed before pain disappeared was 4.34 months(0-23.72). Sensitivity was newly affected in 20.3% of patients with TTN or AFP. Conclusions. Gamma Knife radiosurgery is a first choice therapeutic option for use with patients who have TTN or AFP, as well as in cases of neuralgia associated to MS. It can also be considered for use as re-treatment with a tolerable rate of morbidity (AU)