Stereotactic radiosurgery for trigeminal neuralgia: a scientific assessment.
J Neurosurg. 2018 Apr 27;:1-25
Authors: Tuleasca C, Régis J, Sahgal A, De Salles A, Hayashi M, Ma L, Martínez-Álvarez R, Paddick I, Ryu S, Slotman BJ, Levivier M
OBJECTIVES The goals of this systematic assessment are to offer an goal abstract of the printed literature particular to the remedy of classical trigeminal neuralgia with stereotactic radiosurgery (RS) and to develop consensus guideline suggestions for using RS, as endorsed by the Worldwide Society of Stereotactic Radiosurgery (ISRS). METHODS The authors carried out a scientific assessment of the English-language literature from 1951 as much as December 2015 utilizing the Embase, PubMed, and MEDLINE databases. The next MeSH phrases had been utilized in a title and summary screening: “radiosurgery” AND “trigeminal.” Of the 585 preliminary outcomes obtained, the authors carried out a full textual content screening of 185 research and finally discovered 65 eligible research. Guideline suggestions had been primarily based on degree of proof and degree of consensus, the latter predefined as not less than 85% settlement among the many ISRS guideline committee members. RESULTS The outcomes for 65 research (6461 sufferers) are reported: 45 Gamma Knife RS (GKS) research (5687 sufferers [88%]), 11 linear accelerator (LINAC) RS research (511 sufferers [8%]), and 9 CyberKnife RS (CKR) research (263 sufferers [4%]). Excluding one potential research, all research had been retrospective. The imply maximal doses had been 71.1-90.1 Gy (prescribed on the 100% isodose line) for GKS, 83.Three Gy for LINAC, and 64.Three-80.5 Gy for CKR (the latter two prescribed on the 80% or 90% isodose traces, respectively). The ranges of maximal doses had been as follows: 60-97 Gy for GKS, 50-90 Gy for LINAC, and 66-90 Gy for CKR. Actuarial preliminary freedom from ache (FFP) with out remedy ranged from 28.6% to 100% (imply 53.1%, median 52.1%) for GKS, from 17.Three% to 76% (imply 49.Three%, median 43.2%) for LINAC, and from 40% to 72% (imply 56.Three%, median 58%) for CKR. Particular to hypesthesia, the crude charges (all Barrow Neurological Institute Ache Depth Scale scores included) ranged from zero% to 68.eight% (imply 21.7%, median 19%) for GKS, from 11.four% to 49.7% (imply 27.6%, median 28.5%) for LINAC, and from 11.eight% to 51.2% (imply 29.1%, median 18.7%) for CKR. Different problems included dysesthesias, paresthesias, dry eye, deafferentation ache, and keratitis. Hypesthesia and paresthesia occurred as problems solely when the anterior retrogasserian portion of the trigeminal nerve was focused, whereas the opposite listed problems occurred when the basis entry zone was focused. Recurrence charges ranged from zero% to 52.2% (imply 24.6%, median 23%) for GKS, from 19% to 63% (imply 32.2%, median 29%) for LINAC, and from 15.eight% to 33% (imply 25.eight%, median 27.2%) for CKR. Two GKS collection reported 30% and 45.Three% of sufferers who had been ache free with out remedy at 10 years. CONCLUSIONS The literature is proscribed in its degree of proof, with just one comparative randomized trial (1 vs 2 isocenters) reported to this point. At current, one can conclude that RS is a protected and efficient remedy for drug-resistant trigeminal neuralgia. A lot of consensus statements have been made and endorsed by the ISRS.
PMID: 29701555 [PubMed – as supplied by publisher]