Medial Gamma Knife thalamotomy for intractable pain.
J Neurosurg
; 129(Suppl1): 72-76, 2018 12 01.
Article
em En
| MEDLINE
| ID: mdl-30544296
OBJECTIVEAblative procedures are still useful in the treatment of intractable pain despite the proliferation of neuromodulation techniques. In the paper the authors present the results of Gamma Knife thalamotomy (GKT) in various pain syndromes.METHODSBetween 1996 and 2016, unilateral GKT was performed in 30 patients suffering from various severe pain syndromes in whom conservative treatment had failed. There were 20 women and 10 men in the study population, with a median age of 80 years (range 53-89 years). The pain syndromes consisted of 8 patients with classic treatment-resistant trigeminal neuralgia (TN), 6 with postherpetic TN, 5 with TN and constant pain, 1 with TN related to multiple sclerosis, 3 with trigeminal neuropathic pain, 4 with thalamic pain, 1 with phantom pain, 1 with causalgic pain, and 1 with facial pain. The median follow-up period was 24 months (range 12-180 months). Invasive procedures for pain release preceded GKT in 20 patients (microvascular decompression, glycerol rhizotomy, balloon microcompression, Gamma Knife irradiation of the trigeminal root, and radiofrequency thermolesion). The Leksell stereotactic frame, GammaPlan software, and T1- and T2-weighted sequences acquired at 1.5 T were used for localization of the targeted medial thalamus, namely the centromedian (CM) and parafascicularis (Pf) nucleus. The CM/Pf complex was localized 4-6 mm lateral to the wall of the third ventricle, 8 mm posterior to the midpoint, and 2-3 mm superior to the intercommissural line. GKT was performed using the Leksell Gamma Knife with an applied dose ranging from 145 to 150 Gy, with a single shot, 4-mm collimator. Pain relief after radiation treatment was evaluated. Decreased pain intensity to less than 50% of the previous level was considered successful.RESULTSInitial successful results were achieved in 13 (43.3%) of the patients, with complete pain relief in 1 of these patients. Relief was achieved after a median latency of 3 months (range 2-12 months). Pain recurred in 4 (31%) of 13 patients after a median latent interval of 24 months (range 22-30 months). No neurological deficits were observed.CONCLUSIONSThese results suggest that GKT in patients suffering from severe pain syndromes is a relatively successful and safe method that can be used even in severely affected patients. The only risk of GT for the patients in this study was failure of treatment, as no clinical side effects were observed.
Palavras-chave
BNI = Barrow Neurological Institute; CLp = posterior part of the centrolateral thalamic nucleus; CM = centromedian; GKS = Gamma Knife surgery; GKT = Gamma Knife thalamotomy; Gamma Knife; MVD = microvascular decompression; Pf = parafascicularis; TDP = trigeminal deafferentation pain; TN = trigeminal neuralgia; TN1 = TN originally classified as classic neuralgia; TN2 = TN with mixed constant and episodic pain and burning; TNP = trigeminal neuropathic pain; intractable pain; medial thalamotomy; stereotactic radiosurgery; tcMRgFUS = transcranial magnetic resonance imagingguided focused ultrasound
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Dor Intratável
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Radiocirurgia
Limite:
Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
J Neurosurg
Ano de publicação:
2018
Tipo de documento:
Article
País de publicação:
Estados Unidos