Radiocirugía estereotáctica con acelerador lineal para el tratamiento de la neuralgia trigeminal. Experiencia de nueve años en una sola institución

Serrano-Rubio, Alejandro; Martinez-Manrique, J J; Revuelta-Gutiérrez, Rogelio; Gómez-Amador, Juan Luis; Martínez–Anda, Jaime Jesús; Ponce-Gómez, Juan Antonio; Moreno-Jiménez, Sergio

doi:10.33588/rn.5906.2014177

Cited by 3 publications

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“…However, as occurred in this case, given the chronicity and gradual worsening over time and the intensity of the crises, with the appearance of new areas of the trigeminal nerve affected, pharmacological management by the neurology team was not a valid option over time, despite efficient dosage readjustments. The adverse effects, in addition to pain, suffered by the patient, potentially originated from the pharmacological treatment (2,400 mg of oxcarbazepine daily), among the most common: somnolence, diplopia, dizziness, ataxia, depression of cognitive functions, memory and concentration disorders 10 , the above together with the pharmacoresistance of trigeminal neuralgia in 25-50% of patients 10 , 19 placed in the need for an undertaking of invasive surgical treatments 20 , which were performed without the expected pain relief in time, as was the microvascular decompression.…”

Section: Discussionmentioning

confidence: 99%

“…No obstante, como ocurrió en este caso, que dada la cronicidad y empeoramiento paulatino en el tiempo e la intensidad de las crisis, con aparición de nuevas zonas del nervio trigémino afectadas, el manejo farmacológico por neurología no era una opción válida en el tiempo, a pesar de los reajustes posológicos eficientes. Los efectos adversos, adicionales al dolor, que padecía la paciente, potencialmente originados por el tratamiento farmacológico (2,400 mg de oxcarbazepina diaria), entre los más comunes: somnolencia, diplopías, mareos, ataxia, depresión de funciones cognitivas, trastornos de la memoria y la concentración 10 , lo anterior junto con la farmacorresistencia de la neuralgia del trigémino en el 25-50% de los pacientes 10 , 19 situaba en la necesidad de un emprendimiento de tratamientos quirúrgicos invasivos 20 , que fueron realizados sin el alivio del dolor esperado en el tiempo, como fue la descompresión microvascular.…”

Section: Discussionunclassified

“…Se desestimaron otras opciones como neurolisis del ganglio de gaser y rizotomía, por la posibilidad de un manejo menos invasivo como la radiocirugía, que en casos persistentes de neuralgia del trigémino, forman parte de las opciones dentro de las nuevas guías 3 , 11 , 13 , 14 , 16 por poseer mayor efectividad en eliminación del dolor 3 , 6 y menor probabilidad de complicaciones como: hipoacusia, hipoestesia facial, fístula del líquido cefalorraquídeo o hemorragia postquirúrgica 2 . Por tal motivo con idea de integrar nuevas alternativas y lograr obtener resultados diferentes, se determinó la realización de radiocirugía por CyberKnife, teniendo en cuenta otros reportes de casos y estudios que constatan sus beneficios 3 , 11 - 16 , 19 , además de los antecedentes de diversos procedimientos fallidos realizados a la paciente como acupuntura, medicación exagerada, descompresión microvascular y su sintomatología dolorosa que afectaba la parte social y mental.…”

Section: Discussionunclassified

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Radiocirugía CyberKnife para la neuralgia bilateral del trigémino refractaria. Caso clínico

et al. 2022

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Descripción del caso: Se presenta un caso de paciente femenino de 37 años que padecía neuralgia del trigémino bilateral refractaria, tratada con terapias alternativas, cirugía de descompresión microvascular, analgesia multimodal y terapias de bloqueo sin alivio efectivo del dolor. Hallazgos clínicos: Parestesias y punzadas tipo disparo de intensidad del dolor 10/10 en ramas maxilar y mandibular bilaterales del nervio trigémino, con gatillos nasales e intraorales que imposibilitaban comer, tornándose cada vez más severa desde refractariedad a descompresión microvascular y carbamazepinas, desencadenándose las punzadas incluso en el sueño, provocando somnolencia, animo depresivo y aislamiento social. Tratamiento y resultados: La paciente fue sometida a valoración por equipo interdisciplinario de neurooncología, donde en concordancia con el análisis de la resonancia magnética cerebral y los antecedentes de la paciente, se indicó realización de radiocirugía por Cyberknife en monofracción sobre trigémino izquierdo y posteriormente tratar el contralateral. Al ser tratada con radiocirugía Cyberknife® la paciente refiere mejora absoluta de su dolor desde hace 2 años. Relevancia clínica: La Radiocirugía por Cyberknife aún no es primera línea de manejo en neuralgia del trigémino, sin embargo, debería considerarse ya que diversos estudios han logrado demostrar un aumento en la calidad de vida de los pacientes y alivio del dolor en casos refractarios o graves de dicha patología.

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Section: Discussionmentioning

confidence: 99%

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Radiocirugía CyberKnife para la neuralgia bilateral del trigémino refractaria. Caso clínico

et al. 2022

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“…Images were transferred to the planning computer, performing image fusion, definition of target volume and organs at risk, prescription dose, dose distribution, and treatment planning using Brainlab Elements and BrainLAB iPlan. A single isocenter using a 4‐mm collimator was used to target the CNV root entry zone and a dose of 85 Gy was administered 27–29 …”

Section: Methodsmentioning

confidence: 99%

“…A single isocenter using a 4-mm collimator was used to target the CNV root entry zone and a dose of 85 Gy was administered. [27][28][29]…”

Section: Interventionmentioning

confidence: 99%

Comparison of microvascular decompression, percutaneous radiofrequency rhizotomy, and stereotactic radiosurgery in the treatment of trigeminal neuralgia: A long term quasi‐experimental study

Altamirano,

Jimenez‐Olvera,

Moreno‐Jimenez

et al. 2023

Pain Practice

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BackgroundMicrovascular decompression (MVD), radiofrequency rhizotomy (RFR), and stereotactic radiosurgery (SRS) are surgical techniques frequently used in the treatment of idiopathic trigeminal neuralgia (TN), although the results reported for each of these are diverse.ObjectiveThis study aimed to compare long‐term pain control obtained by MVD, SRS, and RFR in patients with idiopathic TN.MethodsTo compare the results obtained by MVD, SRS, and RFR we chose a quasi‐experimental, ambispective design with control groups but no pretest. A total of 52 participants (MVD n = 33, RFR n = 10, SRS n = 9) were included. Using standardized outcome measures, pain intensity, pain relief, quality of life, and satisfaction with treatment were assessed by an independent investigator. The TREND statement for reporting non‐randomized evaluations was applied. Clinical outcomes were evaluated at the initial postoperative period and at 6 months, 1, 2, 3, 4, and 5 years postoperatively.ResultsMVD has shown better results in pain scales compared to ablative procedures. Significant differences between groups were found regarding pain intensity and pain relief at the initial postoperative period (p < 0.001) and 6 months (p = 0.022), 1 year (p < 0.001), 2 years (p = 0.002), and 3 years (p = 0.004) after the intervention. Those differences exceeded the thresholds of the minimal clinically important difference. A higher percentage of patients free of pain was observed in the group of patients treated by MVD, with significant differences at the initial postoperative period (p < 0.001) and 6 months (p = 0.02), 1 year (p = 0.001), and 2 years (p = 0.04) after the procedure. Also, a higher risk of pain recurrence was observed in the RFR and SRS groups (HR 3.15, 95% CI 1.33–7.46; p = 0.009; and HR 4.26, 95% CI 1.77–10.2; p = 0.001, respectively) compared to the MVD group. No significant differences were found in terms of quality of life and satisfaction with treatment. A higher incidence of complications was observed in the MVD group.ConclusionConcerning pain control and risk of pain recurrence, MVD is superior to RFR and SRS, but not in terms of quality of life, satisfaction with treatment, and safety profile.

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Ultra-extended euthermic pulsed radiofrequency for the treatment of ophthalmic neuralgia: A case report with elaboration of a new technique

Bhatjiwale¹,

Bhagat²

2016

Surg Neurol Int

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Background:Pulsed radiofrequency although present for many years has been used little compared to ablative procedures for pain relief. Its use in trigeminal neuralgia is sparse and unreported in the ophthalmic division, where the possibility of sensory loss can lead to high morbidity. We wished to explore the potential of this reportedly safe modality for a prolonged duration in a highly sensitive anatomic neural location, however, in a very secure, structured, and staged manner.Case Description:A patient suffering from ophthalmic division (V1) medically uncontrolled neuralgia with a preoperative visual analog scale (VAS) score of 9/10 was subjected to a percutaneous pain relief procedure. The patient was treated with prolonged duration pulsed radiofrequency (PRF) for 40 min, with corneal sensation monitoring under conscious sedation keeping a low voltage (7 V) and tip temperature at 37°C. The patient obtained immediate relief, which was verified on the operation table itself. Postoperative VAS score of 0/10 was recorded. More than 6 months after the procedure, the patient is completely free from neuralgic pain and continues to have a VAS score of 0/10.Conclusion:As opposed to conventional PRF where mostly a tip temperature of 42°C and high voltage have been used for 2 to a maximum of 8 min, PRF with a tip temperature of 37°C and a safe voltage of 7 V over an ultra-extended duration of 40 min can give a more distinct and effective but equally safe result. Although our case verified the safety and efficacy of prolonged duration PRF in sensitive anatomic locations, more studies are warranted for establishing this as a standard line of treatment. The specific use of PRF in ophthalmic division neuralgia in the manner described in our case report has hitherto not been reported in medical literature and will open a new vista in the minimally invasive treatment of this disease.

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Radiocirugía estereotáctica con acelerador lineal para el tratamiento de la neuralgia trigeminal. Experiencia de nueve años en una sola institución

Cited by 3 publications

References 0 publications

Radiocirugía CyberKnife para la neuralgia bilateral del trigémino refractaria. Caso clínico

Radiocirugía CyberKnife para la neuralgia bilateral del trigémino refractaria. Caso clínico

Comparison of microvascular decompression, percutaneous radiofrequency rhizotomy, and stereotactic radiosurgery in the treatment of trigeminal neuralgia: A long term quasi‐experimental study

Ultra-extended euthermic pulsed radiofrequency for the treatment of ophthalmic neuralgia: A case report with elaboration of a new technique

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