Resultados de la aplicación de radiocirugía con acelerador lineal en pacientes con neuralgia del trigémino / Outcome of radiosurgery treatment with a linear accelerator in patients with trigeminal neuralgia

Introducción. Comprobación de la efectividad de la radiocirugía en pacientes diagnosticados de neuralgia del v par y análisis de posibles factores predictores. Métodos. Se analizaron todos los pacientes entre 2004 y 2011 tratados mediante radiocirugía con acelerador lineal. Se administraron dosis de 60Gy a 1-2mm de la entrada del nervio con isodosis de 20% máxima sobre el tronco. Se analizaron los resultados clínicos de control del dolor y efectos secundarios a los 12 y 36 meses (escala BNI). Resultados. Se incluyó a 71 pacientes en el estudio (seguimiento medio 50,50m). La mejoría del dolor a los 12 meses fue del 68,11% (28,98% BNI score I-II; 39,12% BNI score III y a los 36 meses del 58,21% (23,88% BNI score I-II; 34,32% BNI score III). El tiempo medio de mejoría fue de 3,69 meses y la tasa de reincidencia tras mejoría del 44,68%. Se aprecian diferencias estadísticas en la mejoría para pacientes con dolores típicos a los 12 y 36 meses (p<0,047 y p<0,002). Se analiza el inicio de la mejoría mediante gráficas de Kaplan-Meyer. En el análisis en función de variables se obtuvo diferencia estadísticamente significativa entre dolores típicos y atípicos a los 36 meses (p<0,012). En 15 pacientes se registraron efectos secundarios (20,89%), 9 de ellos por adormecimiento facial (13,43%) y solo 2 con relevancia clínica (2,98%). Conclusiones. De acuerdo con nuestra experiencia, la radiocirugía es un tratamiento eficaz de la neuralgia del trigémino, con escasos efectos secundarios. El dolor típico parece un factor de buen pronóstico para la mejoría del dolor (AU)

Introduction. An overview of the effectiveness of radiosurgery in patients diagnosed with trigeminal neuralgia with an analysis of potential predictors of good outcome. Methods. All patients treated with linear accelerator radiosurgery between 2004 and 2011 were analysed. A dose of 60Gy dose was administered 1 to 2mm from the root entry zone with a maximum isodose of 20% delivered to the brainstem. Clinical results for pain control and any side effects were analysed at 12 and 36 months (BNI score). Results. The study included 71 patients (mean follow-up 50.5 months). Pain improvement at 12 months was observed in 68.11% of the total (28.98% with BNI score I-II; 39.12% with BNI score III) and at 36 months in 58.21% (23.88% BNI score I-II; 34.32% BNI score III). Average recovery time was 3.69 months and the relapse rate was 44.68%. Patients with typical pain displayed statistically significant differences in improvement rates at 12 and at 36 months (P<047 and P<.002). Onset of improvement was analysed using Kaplan-Meyer plots. Statistically significant differences were observed between patients with typical and atypical pain at 36 months (P<.012) in Kaplan-Meyer plots. Side effects were recorded in 15 patients (20.89%), including 9 cases of facial numbness (13.43%); only 2 cases were clinically relevant (2.98%). Conclusion. According to our results, radiosurgery is an effective treatment for trigeminal neuralgia, with few side effects. Typical pain seems to be a good predictor of pain relief (AU)

Outcome of radiosurgery treatment with a linear accelerator in patients with trigeminal neuralgia. / Resultados de la aplicación de radiocirugía con acelerador lineal en pacientes con neuralgia del trigémino.

INTRODUCTION: An overview of the effectiveness of radiosurgery in patients diagnosed with trigeminal neuralgia with an analysis of potential predictors of good outcome. METHODS: All patients treated with linear accelerator radiosurgery between 2004 and 2011 were analysed. A dose of 60Gy dose was administered 1 to 2mm from the root entry zone with a maximum isodose of 20% delivered to the brainstem. Clinical results for pain control and any side effects were analysed at 12 and 36 months (BNI score). RESULTS: The study included 71 patients (mean follow-up 50.5 months). Pain improvement at 12 months was observed in 68.11% of the total (28.98% with BNI score i-ii; 39.12% with BNI score iii) and at 36 months in 58.21% (23.88% BNI score i-ii; 34.32% BNI score iii). Average recovery time was 3.69 months and the relapse rate was 44.68%. Patients with typical pain displayed statistically significant differences in improvement rates at 12 and at 36 months (P<047 and P<.002). Onset of improvement was analysed using Kaplan-Meyer plots. Statistically significant differences were observed between patients with typical and atypical pain at 36 months (P<.012) in Kaplan-Meyer plots. Side effects were recorded in 15 patients (20.89%), including 9 cases of facial numbness (13.43%); only 2 cases were clinically relevant (2.98%). CONCLUSION: According to our results, radiosurgery is an effective treatment for trigeminal neuralgia, with few side effects. Typical pain seems to be a good predictor of pain relief.

[Multiple calcified cerebral lesions, probably due to metastasis]. / Multiples lesiones cerebrales calcificadas de probable origen metastásico.

INTRODUCTION: Metastases are an infrequent (though possible) cause of cerebral calcifications due to the speed with which they grow. We report the case of a patient in whom some metastatic looking calcified cerebral lesions led to the discovery that she was suffering from lung cancer. CASE REPORT: Woman, aged 60, with no antecedents of interest except hyperlipaemia who came to clinic after suffering from alterations of her higher functions for three weeks. Nothing abnormal was found during the general exploration. Neurologically, she was found to have sensory aphasia together with impaired gnosia and praxis. A brain CAT scan revealed several calcified cerebral lesions throughout both hemispheres, associated with perilesional edema and mass effect with contrast enhancement. Cerebral MRI confirmed these findings. X ray of the thorax was normal but the thoracic CAT scan revealed a spiculated lesion that suggested a malign primary lung neoplasia. CONCLUSION: The presence of cerebral calcifications with perilesional edema and contrast enhancement forces us to rule out a metastatic origin. Although no respiratory clinical features are present, a study of the lungs should be performed as they are the most probable source of the aetiology.

Múltiples lesiones cerebrales calcificadasde probable origen metastásico / Multiple calcified cerebral lesions, probably due to metastasis

Introducción. Las metástasis son una causa infrecuente (aunque posible) de calcificaciones cerebrales debido a su rápido crecimiento. Se presenta el caso de una enferma a la que se detectó una tumoración pulmonar a través de unas lesiones cerebrales calcificadas con aspecto metastásico. Caso clínico. Mujer de 60 años sin antecedentes de interés, salvo una hiperlipemia, que consultó por un cuadro de alteración de funciones superiores de tres semanas de evolución. La exploración general fue normal. Neurológicamente destacaba una afasia sensitiva junto con trastornos gnósicos y práxicos. En la tomografía axial computarizada (TAC) craneal se observaron varias lesiones cerebrales calcificadas, distribuidas por ambos hemisferios, asociadas a un edema perilesional y efecto masa con captación de contraste. La resonancia magnética craneal refrendó dichos hallazgos. La radiografía del tórax fue normal, pero en la TAC torácica se evidenció una lesión de contornos espiculados sugerente de neoplasia pulmonar primaria maligna. Conclusión. La presencia de calcificaciones cerebrales con edema perilesional o captación de contraste obliga a descartar un origen metastásico. Para ello es recomendable el estudio de los pulmones, aunque no exista clínica respiratoria, como primera posibilidad etiológica (AU)