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Introducción: La radiocirugía estereotáctica con Gamma Knife® (GK), sobre el núcleo ventral intermedio-medial del tálamo (VIM), unilateral es una opción neuroquirúrgica mínimamente invasiva para el temblor refractario. Se describe la experiencia de talamotomía con GK (TGK) en pacientes con temblor esencial (TE) y enfermedad de Parkinson (EP) de predominio tremórico de una unidad especializada en cirugía estereotáctica.MétodosSe revisan los pacientes tratados con TGK desde enero de 2014 hasta febrero de 2018. Se analizan variables clínico-demográficas, indicación, dosis empleada, eficacia (mediante subescalas de Fahn-Tolosa-Marin (FTM) y MDS-UPDRS motora) y efectos adversos (EA).ResultadosSe registraron 13 pacientes, seis con diagnóstico de EP de predominio tremórico, cuetro con TE refractario y tres casos de TE + EP. La mediana de edad fue 78 años (62-83), con siete pacientes > 75 años. Cuatro pacientes anticoagulados y dos con antecedentes de ictus previo. La dosis máxima de radiación aplicada fue 130 Gy. La media de seguimiento fue 30,0 (14,5) meses. Se observó una mejoría significativa del temblor en las subescalas de FTM del 63,6% a 12 meses y del 63,5% al final del seguimiento y en items de temblor de MDS-UPDRS del 71,3% a 12 meses y del 60,3% al final del seguimiento. Once pacientes refirieron mejoría significativa en su calidad de vida. Tres pacientes refirieron EA leves y transitorios.ConclusionesSe presenta la mayor serie de pacientes con TE y parkinsoniano tratados con TGK en España con seguimiento a largo plazo. La TGK puede ser un tratamiento seguro y con eficacia mantenida en temblor refractario, incluso en edad avanzada o en tratamiento anticoagulante. (AU)
Introduction: Unilateral Gamma Knife stereotactic radiosurgery on the ventral-intermediate nucleus of the thalamus is a minimally invasive neurosurgical option for refractory tremor. We describe the experience of Gamma Knife thalamotomy (GKT) in patients with essential tremor (ET) and tremor-dominant Parkinson's disease (PD) at our specialised stereotactic neurosurgery unit.MethodsWe reviewed the cases of patients treated with GKT between January 2014 and February 2018 with a minimum of 12 months follow-up. We analysed clinical and demographic variables, indication, radiation dose, effectiveness (based on subscales of the Fahn-Tolosa-Marin [FTM] scale and the Movement Disorders Society-Unified Parkinson's Disease Rating Scale [MDS-UPDRS] motor score), and adverse events.ResultsThirteen patients were registered, 6 with a diagnosis of tremor-dominant PD, four with refractory ET, and three with ET and PD. Median age was 78 years (range, 62-83), with seven patients aged over 75 years. Four patients were receiving anticoagulants and two had history of stroke. The maximum radiation dose administered was 130 Gy. Mean (standard deviation) follow-up duration was 30.0 (14.5) months. Significant tremor improvement was observed on the FTM subscales: 63.6% at 12 months and 63.5% at the end of follow-up; MDS-UPDRS tremor items showed improvements of 71.3% at 12 months and 60.3% at the end of follow up. Eleven patients reported significant improvements in quality of life, and 3 reported mild and transient adverse effects.ConclusionsThis is the largest series of patients with essential and parkinsonian tremor treated with GKT and followed up in the long term in Spain. GKT can be safe and effective in the long term in patients with refractory tremor, including in elderly patients and those receiving anticoagulants. (AU)
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Humanos , Radiocirurgia , Tremor Essencial , Doença de ParkinsonRESUMO
INTRODUCTION: Unilateral Gamma Knife™ stereotactic radiosurgery on the ventral-intermediate nucleus of the thalamus is a minimally invasive neurosurgical option for refractory tremor. We describe the experience of Gamma Knife™ thalamotomy (GKT) in patients with essential tremor (ET) and tremor-dominant Parkinson's disease (PD) at our specialised stereotactic neurosurgery unit. METHODS: We reviewed the cases of patients treated with GKT between January 2014 and February 2018 with a minimum of 12 months' follow-up. We analysed clinical and demographic variables, indication, radiation dose, effectiveness (based on subscales of the Fahn-Tolosa-Marin [FTM] scale and the Movement Disorders Society-Unified Parkinson's Disease Rating Scale [MDS-UPDRS] motor score), and adverse events. RESULTS: Thirteen patients were registered, 6 with a diagnosis of tremor-dominant PD, four with refractory ET, and three with ET and PD. Median age was 78 years (range, 62-83), with seven patients aged over 75 years. Four patients were receiving anticoagulants and two had history of stroke. The maximum radiation dose administered was 130 Gy. Mean (standard deviation) follow-up duration was 30.0 (14.5) months. Significant tremor improvement was observed on the FTM subscales: 63.6% at 12 months and 63.5% at the end of follow-up; MDS-UPDRS tremor items showed improvements of 71.3% at 12 months and 60.3% at the end of follow up. Eleven patients reported significant improvements in quality of life, and 3 reported mild and transient adverse effects. CONCLUSIONS: This is the largest series of patients with essential and parkinsonian tremor treated with GKT and followed up in the long term in Spain. GKT can be safe and effective in the long term in patients with refractory tremor, including in elderly patients and those receiving anticoagulants.
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Tremor Essencial , Doença de Parkinson , Radiocirurgia , Idoso , Humanos , Tremor/etiologia , Resultado do Tratamento , Qualidade de Vida , Radiocirurgia/efeitos adversos , Seguimentos , Imageamento por Ressonância Magnética , Tremor Essencial/radioterapia , Tremor Essencial/etiologia , Tremor Essencial/cirurgiaRESUMO
INTRODUCTION: Unilateral Gamma Knife™ stereotactic radiosurgery on the ventral-intermediate nucleus of the thalamus is a minimally invasive neurosurgical option for refractory tremor. We describe the experience of Gamma Knife™ thalamotomy (GKT) in patients with essential tremor (ET) and tremor-dominant Parkinson's disease (PD) at our specialised stereotactic neurosurgery unit. METHODS: We reviewed the cases of patients treated with GKT between January 2014 and February 2018 with a minimum of 12 months' follow-up. We analysed clinical and demographic variables, indication, radiation dose, effectiveness (based on subscales of the Fahn-Tolosa-Marin [FTM] scale and the Movement Disorders Society-Unified Parkinson's Disease Rating Scale [MDS-UPDRS] motor score), and adverse events. RESULTS: Thirteen patients were registered, 6 with a diagnosis of tremor-dominant PD, four with refractory ET, and three with ET and PD. Median age was 78 years (range, 62-83), with seven patients aged over 75 years. Four patients were receiving anticoagulants and two had history of stroke. The maximum radiation dose administered was 130 Gy. Mean (standard deviation) follow-up duration was 30.0 (14.5) months. Significant tremor improvement was observed on the FTM subscales: 63.6% at 12 months and 63.5% at the end of follow-up; MDS-UPDRS tremor items showed improvements of 71.3% at 12 months and 60.3% at the end of follow up. Eleven patients reported significant improvements in quality of life, and 3 reported mild and transient adverse effects. CONCLUSIONS: This is the largest series of patients with essential and parkinsonian tremor treated with GKT and followed up in the long term in Spain. GKT can be safe and effective in the long term in patients with refractory tremor, including in elderly patients and those receiving anticoagulants.
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INTRODUCTION: Typical trigeminal neuralgia (TTN) is a condition that is treated initially by pharmacological means and, if this fails, with different surgical techniques. With the advent of radiosurgery a relatively bloodless form of treatment with low toxicity and good results has become available and can be considered for use as the first choice procedure. AIMS: Our aim was to report the findings obtained from treating this pathology using Gamma Knife radiosurgery in order to assess the possibility of using it for patients with neuralgia associated to multiple sclerosis (MS) or who have atypical facial pain (AFP). We also assessed the patients who were re-treated owing to recurrence or persistence. PATIENTS AND METHODS: The sample was made up of 74 patients, including seven cases of lesions in the brain stem at the nerve entry point, 45 cases of associated vascular compression, 15 cases of AFP and eight cases of re-treatment. The median maximum dose was 84 Gy (60.2-120). The mean follow-up time was 23.26 months (1-97.83). RESULTS: Of those with TTN, 76.2% of subjects had no pain at the end of the study (75% in cases of second treatments, 69% in cases of associated vascular compression, 52% of those with prior interventions and 43% with MS), and 33% in the case of AFP. The mean time elapsed before pain disappeared was 4.34 months (0-23.72). Sensitivity was newly affected in 20.3% of patients with TTN or AFP. CONCLUSIONS: Gamma Knife radiosurgery is a first choice therapeutic option for use with patients who have TTN or AFP, as well as in cases of neuralgia associated to MS. It can also be considered for use as re-treatment with a tolerable rate of morbidity.
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Dor Facial/cirurgia , Radiocirurgia/instrumentação , Neuralgia do Trigêmeo/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste/metabolismo , Descompressão Cirúrgica/instrumentação , Descompressão Cirúrgica/métodos , Gadolínio/metabolismo , Humanos , Pessoa de Meia-Idade , Radiocirurgia/métodos , Recidiva , Reoperação , Estudos Retrospectivos , Neuralgia do Trigêmeo/patologiaRESUMO
Introducción. La neuralgia típica del trigémino (NTT) es una patología tratada en primera instancia farmacológicamente y,si esto fracasa, con distintas técnicas quirúrgicas. Con la llegada de la radiocirugía, se puede optar por un tratamiento poco cruento con escasa toxicidad y buenos resultados que puede plantearse como primera alternativa. Objetivo. Presentar los resultados obtenidos al tratar esta patología mediante radiocirugía con Gamma nife de manera que se valore su posible uso también para pacientes con neuralgia asociada a esclerosis múltiple (EM) o afectos de dolor facial atípico (DFA). También evaluamos a los pacientes retratados por recidiva o persistencia. Pacientes y métodos. 74 pacientes, incluidos siete casos con lesiones en el tronco cerebral en la entrada del nervio, 45 compresiones vasculares asociadas, 15 casos de DFA y ocho retratamientos. La dosis máxima media ha resultado84 Gy (60,2-120). El seguimiento medio ha sido de 23,26meses (1-97,83). Resultados. En la NTT, un 76,2% no presentaba dolor al cierre del estudio (un 75% en segundos tratamientos, un 69%en casos de compresión vascular asociada, un 52% con intervenciones previas y un 43% con EM) y 33% en casos de DFA. El tiempo medio para la desaparición del dolor fue de 4,34 meses (0-23,72).Hay nuevas alteraciones de la sensibilidad en el 20,3% de pacientes con NTT o DFA. Conclusiones. La radiocirugía con Gamma Knife representa una alternativa como primera opción de tratamiento en pacientes con NTT y DFA, así como en la neuralgia asociada a EM. Incluso puede plantearse como retratamiento con tolerable morbilidad (AU)
Introduction. Typical trigeminal neuralgia (TTN) is a condition that is treated initially by pharmacological means and, if this fails, with different surgical techniques. With the advent of radiosurgery a relatively bloodless form of treatment with low toxicity and good results has become available and can be considered for use as the first choice procedure. Aims. Our aim was to report the findings obtained from treating this pathology using Gamma Knife radiosurgery in order to assess the possibility of using it for patients with neuralgia associated to multiple sclerosis (MS) or who have atypical facial pain (AFP).We also assessed the patients who were re-treated owing to recurrence or persistence. Patients and methods. The sample was made up of 74 patients, including seven cases of lesions in the brain stem at the nerve entry point, 45 cases of associated vascular compression, 15 cases of AFP and eight cases of re-treatment. The median maximum dose was 84 Gy (60.2-120). The mean follow-up time was 23.26 months (1-97.83). Results. Of those with TTN, 76.2% of subjects had no pain at the end of the study (75% in cases of second treatments, 69% in cases of associated vascular compression, 52% of those with prior interventions and 43% with MS), and 33% in the case of AFP. The mean time elapsed before pain disappeared was 4.34 months(0-23.72). Sensitivity was newly affected in 20.3% of patients with TTN or AFP. Conclusions. Gamma Knife radiosurgery is a first choice therapeutic option for use with patients who have TTN or AFP, as well as in cases of neuralgia associated to MS. It can also be considered for use as re-treatment with a tolerable rate of morbidity (AU)