ABSTRACT
ABSTRACT Gamma Knife® radiosurgery (GKRS) for trigeminal neuralgia is an effective treatment with at least a 50% reduction of pain in 75-95% of patients. Objective: To present the first series of patients treated for trigeminal neuralgia using GKRS in Latin America. Methods: Retrospective analysis. Analysis consisted of time to improvement of symptoms, best Barrow Neurological Institute scale (BNI) score after procedure, time without pain, time to recurrence and post-procedural hypoesthesia. Results: Nineteen cases of classical trigeminal neuralgia were analyzed and three cases of symptomatic trigeminal neuralgia were described. Mean time from symptom onset to radiosurgery was 99.6 months, and 78.9% of patients had undergone invasive procedures before treatment. Patients were followed for a mean of 21.7 months. BNI I was achieved in 36.8%, IIIa in 21.1%, IIIb in 21.1%, IV in 5.3% and V in 15.7%. New hypoesthesia developed in 12.1% patients, which was associated with achieving BNI I after the procedure (p < 0.05). Time from diagnosis to GKRS was higher in patients who failed to achieve BNI I (143 vs. 76 months). The distance from the root entry zone in patients who achieved BNI I was greater than patients who did not (1.94 vs. 1.14 mm). Mean distance from the root entry zone in patients with new hypoesthesia was 2.85 mm vs. 1.06 mm (p = 0.06). Conclusion: Clinical response to GKRS is related to the time between diagnosis and procedure, thus its indication should be considered early in the management of these patients.
RESUMO A radiocirurgia por Gamma Knife (GKRS) para neuralgia do trigêmeo é um tratamento comprovado, com redução de pelo menos 50% da dor em 75-95% dos casos. Objetivo: Apresentar a primeira série de pacientes tratados por neuralgia do trigêmeo com GKRS na America Latina. Métodos: Análise retrospectiva. A análise consistiu no tempo até melhora do sintoma, melhor escala do Barrow Neurological Institute (BNI) depois do procedimento, tempo sem dor, tempo até recorrência e hipoestesia pós-procedimento. Resultados: Dezenove casos de neuralgia do trigêmeo clássica foram analisados e três casos de neuralgia do trigêmeo sintomática foram descritos. Tempo médio entre começo dos sintomas e GKRS foi de 99,6 meses e 78,9% dos pacientes já tinham sido submetidos a procedimento invasivo prévio. O tempo de acompanhamento médio foi de 21,7 meses. BNI I foi conseguido em 36,8%, IIIa em 21,1%, IIIb em 21,1%, IV em 5,3% e V em 15,7%. Nova hipoestesia apareceu em 12,1% dos casos, o que foi associado a conseguir BNI I pós-procedimento (p < 0,05). Tempo desde o diagnóstico até GKRS foi maior em pacientes que não conseguiram BNI I (143 vs. 76 meses). Distância da zona de entrada do nervo em pacientes que conseguiram BNI I foi maior (1,94 vs. 1,14mm). Distância do zona de entrada do nervo em pacientes com nova hipoestesia foi de 2,85mm vs. 1,06mm (p = 0,06) Conclusão: A resposta à GKRS está relacionada ao tempo entre diagnóstico e procedimento, pelo que a indicação de GKRS deve ser considerada cedo no tratamento desses pacientes.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Trigeminal Neuralgia/radiotherapy , Radiosurgery/methods , Recurrence , Time Factors , Pain Measurement , Reproducibility of Results , Retrospective Studies , Follow-Up Studies , Treatment Outcome , Rhizotomy/methods , Dose-Response Relationship, Radiation , Latin AmericaABSTRACT
To compare sizes of the foramen ovale and rotundum in trigeminal neuralgia [TN] patients and healthy individuals on CT images. Twenty-one TN patients and 24 healthy volunteers were included in the retrospectively designed study, carried out at the Department of Anatomy, Medical School, Gaziantep University, Gaziantep, Turkey, between May 2004 and August 2009. The dimension of the foramen ovale on the cross-sectional images, and the foramen rotundum on coronal sections on CT images were examined. The mean sizes of the foramen rotundum on the right and left sides were 3.04x3.2 mm and 2.8x2.9 mm in TN patients, and 2.4x3.2 mm and 2.5x3.1 mm in controls. The mean sizes of the foramen ovale on the right and left sides were 4.8x6.04 mm and 4.9x5.5 mm in TN patients, and 3.7x8.2 mm and 4.1x7.6 mm in controls.The dimension of left and right foramens were not significantly different in both TN patients, and 3.7x8.2 mm and 4.1x7.6 mm in controls. The dimensions of left and right foramens were not significantly different in both TN patients and controls [p>0.05]. Furthermore, a statistically significant difference was not found between the foraminal dimensions of the TN patients and controls [p>0.05]. This study revealed that the sizes of foramen ovale and rotundum are highly symmetrical in both groups, suggesting that sizes of the foramina are not associated with the occurrence of TN
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Tomography, X-Ray Computed , Trigeminal Neuralgia/pathology , Trigeminal Neuralgia/radiotherapy , Sphenoid Bone/diagnostic imaging , Retrospective Studies , Functional LateralityABSTRACT
Se presenta un estudio en 15 pacientes con diagnóstico de neuralgia trigeminal, que se organizaron en 3 grupos, según el tratamiento recibido: grupo A: tratamiento con fármacos; grupo B: tratamiento con radiaciones láser HeNe; grupo C: combinación de terapia láser HeNe y fármacos. Se compararon los resultados obtenidos en cada grupo estudiado y se observó la rapidez y efectividad de la radiación láser helioneón en la disminución de la crisis dolorosa, fundamentalmente cuando se combina con tratamiento de fármacos.