Radiocirugía estereotáctica con acelerador lineal para el tratamiento de la neuralgia trigeminal. Experiencia de nueve años en una sola institución / Linear accelerator-based stereotactic radiosurgery for the treatment of trigeminal neuralgia. Nine years’ experience in a single institution

Introducción. El tratamiento farmacológico constituye el primer escalón terapéutico para el control del dolor en la neuralgia del trigémino, pero entre el 25-50% de los pacientes se hace farmacorresistente. Actualmente existen varias alternativas quirúrgicas para tratar a estos pacientes. Objetivo. Evaluar la efectividad y seguridad de la radiocirugía estereotáctica para el tratamiento de pacientes con neuralgia del trigémino. Pacientes y métodos. Se dio seguimiento a 30 pacientes que se sometieron a radiocirugía con acelerador lineal Novalis. Se calculó el 80% de la dosis en el isocentro, la zona de raíz de entrada del nervio trigémino. El tiempo medio de seguimiento fue de 27,5 meses (rango: 1-65 meses). Resultados. La edad media fue de 66 años (rango: 36-87 años), con un tiempo de evolución de 7,1 años (rango: 4-27 años). La distribución del dolor fue del lado derecho (63,3%). De los 30 pacientes, 27 tuvieron mejoría (90%) 1,6 meses (rango: 1 semana-4 meses) después del tratamiento; 10 pacientes (33,3%) tuvieron una valoración de grado I y 17 pacientes (56,6%) una valoración de grado II. Durante el seguimiento, cuatro pacientes (14,2%) tuvieron recidiva; dos se sometieron a reirradiación. El tiempo sin recurrencia fue de 62,7 meses (rango: 54,6-70,8 meses). La tasa de efectos secundarios fue del 76,7%, y sólo tres pacientes desarrollaron anestesia facial con pérdida del reflejo corneal. Conclusiones. El uso del acelerador lineal es una opción terapéutica efectiva en el tratamiento de la neuralgia del trigémino, proporciona a largo plazo adecuado control del dolor, reduce el uso de medicamentos y mejora la calidad de vida (AU)

Introduction. Pharmacological treatment is the first therapeutic step towards controlling pain in trigeminal neuralgia, but 25-50% of patients become medication resistant. There are currently several surgical alternatives for treating these patients. Aim. To evaluate the effectiveness and safety of stereotactic radiosurgery for the treatment of patients with trigeminal neuralgia. Patients and methods. A follow-up study was conducted on 30 patients who underwent radiosurgery using a Novalis linear accelerator. Eighty per cent of the dosage was calculated at the isocentre, the entry zone of the root of the trigeminal nerve. The mean follow-up time was 27.5 months (range: 1-65 months). Results. The mean age was 66 years (range: 36-87 years), with a time to progression of 7.1 years (range: 4-27 years). The distribution of the pain was from the right side (63.3%). Of the 30 patients, 27 experienced an improvement (90%) 1.6 months (range: 1 week-4 months) after the treatment; 10 patients (33.3%) scored grade I, and 17 patients (56.6%) obtained a score of grade II. During the follow-up, four patients (14.2%) suffered a relapse; two underwent re-irradiation. Time without recurrence was 62.7 months (range: 54.6-70.8 months). The rate of side effects was 76.7% and only three patients developed facial anaesthesia with loss of the corneal reflex. Conclusions. The use of the linear accelerator is an effective therapeutic option in the treatment of trigeminal neuralgia, since it provides adequate long-term control of the pain, reduces the use of medication and improves the quality of life (AU)

3T MRI and 128-slice dual-source CT cisternography images of the cranial nerves a brief pictorial review for clinicians.

There is a broad community of health sciences professionals interested in the anatomy of the cranial nerves (CNs): specialists in neurology, neurosurgery, radiology, otolaryngology, ophthalmology, maxillofacial surgery, radiation oncology, and emergency medicine, as well as other related fields. Advances in neuroimaging using high-resolution images from computed tomography (CT) and magnetic resonance (MR) have made highly-detailed visualization of brain structures possible, allowing normal findings to be routinely assessed and nervous system pathology to be detected. In this article we present an integrated perspective of the normal anatomy of the CNs established by radiologists and neurosurgeons in order to provide a practical imaging review, which combines 128-slice dual-source multiplanar images from CT cisternography and 3T MR curved reconstructed images. The information about the CNs includes their origin, course (with emphasis on the cisternal segments and location of the orifices at the skull base transmitting them), function, and a brief listing of the most common pathologies affecting them. The scope of the article is clinical anatomy; readers will find specialized texts presenting detailed information about particular topics. Our aim in this article is to provide a helpful reference for understanding the complex anatomy of the cranial nerves.

Efficacy and safety of root compression of trigeminal nerve for trigeminal neuralgia without evidence of vascular compression.

OBJECTIVE: Trigeminal neuralgia (TN) surgical treatment with microvascular decompression is highly effective and safe, but for a percentage of patients who undergo this procedure, no vascular compression is found. The purpose of this study was to evaluate the long-term efficacy with trigeminal root compression of the trigeminal nerve in patients with TN refractory to medical treatment who underwent neurosurgical management by a retrosigmoid approach of the cerebellopontine angle and were found to be negative for vascular compression. METHODS: A prospective collection of clinical data on all patients with a diagnosis of idiopathic TN was conducted at our institution. A total of 277 patients with TN were treated by a keyhole retrosigmoid approach for exploration of the cerebellopontine angle between January of 2000 and August of 2010. A total of 44 patients were found to be negative for vascular compression of the trigeminal nerve; all of these patients underwent trigeminal root compression. RESULTS: We found that all patients were pain free after the procedure. There was a 27% relapse in a mean time of 10 months, but 83% of these patients were adequately controlled by medical treatment, and only 17% needed a complementary procedure for pain relief. We also found that 63% of the patients complained of a partial loss of facial sensitivity, but only 1 patient presented with a corneal ulcer. There was a 6.7% rate of significant complications. CONCLUSIONS: We concluded that trigeminal root compression is a safe and effective option for patients with primary TN without vascular compression.