Abstract：
Gamma Knife radiosurgery is recognized as an efficient intervention for the treatment of refractory trigeminal neuralgia (TN). The CyberKnife, a more recent frameless and nonisocentric radiosurgery alternative, has not been studied as extensively for this condition. This study aims to evaluate the clinical outcomes of a first CyberKnife radiosurgery (CKRS) treatment in patients with medically refractory TN.
A retrospective cohort study of 166 patients (168 procedures) with refractory TN treated from 2009 to 2021 at the Centre Hospitalier de l\'Université de Montréal was conducted. The treatment was performed using a CyberKnife (model G4, VSI, or M6). The treatment median maximum dose was 80 (range 70.0-88.9) Gy.
Adequate pain relief, evaluated using Barrow Neurological Institute pain scale scores (I-IIIb), was achieved in 146 cases (86.9%). The median latency period before adequate pain relief was 35 (range 0-202) days. The median duration of pain relief for cases with a recurrence of pain was 8.3 (range 0.6-85.0) months. The actuarial rates of maintaining adequate pain relief at 12, 36, and 60 months from the treatment date were 77.0%, 62.5%, and 50.2%, respectively. There was new onset or aggravation of facial numbness in 44 cases (26.2%). This facial numbness was predictive of better maintenance of pain relief (p < 0.001). The maintenance of adequate pain relief was sustained longer in idiopathic cases compared with cases associated with multiple sclerosis (MS; p < 0.001).
In the authors\' experience, CKRS for refractory TN is efficient and safe. The onset or aggravation of facial hypoesthesia after treatment was predictive of a more sustained pain relief, and idiopathic cases had more sustained pain relief in comparison with MS-related cases.
A retrospective cohort study of 166 patients (168 procedures) with refractory TN treated from 2009 to 2021 at the Centre Hospitalier de l\'Université de Montréal was conducted. The treatment was performed using a CyberKnife (model G4, VSI, or M6). The treatment median maximum dose was 80 (range 70.0-88.9) Gy.
Adequate pain relief, evaluated using Barrow Neurological Institute pain scale scores (I-IIIb), was achieved in 146 cases (86.9%). The median latency period before adequate pain relief was 35 (range 0-202) days. The median duration of pain relief for cases with a recurrence of pain was 8.3 (range 0.6-85.0) months. The actuarial rates of maintaining adequate pain relief at 12, 36, and 60 months from the treatment date were 77.0%, 62.5%, and 50.2%, respectively. There was new onset or aggravation of facial numbness in 44 cases (26.2%). This facial numbness was predictive of better maintenance of pain relief (p < 0.001). The maintenance of adequate pain relief was sustained longer in idiopathic cases compared with cases associated with multiple sclerosis (MS; p < 0.001).
In the authors\' experience, CKRS for refractory TN is efficient and safe. The onset or aggravation of facial hypoesthesia after treatment was predictive of a more sustained pain relief, and idiopathic cases had more sustained pain relief in comparison with MS-related cases.
摘要：
伽玛刀放射外科被认为是治疗难治性三叉神经痛（TN）的有效干预措施。赛波刀,最近的无框和非等中心放射外科替代方案，尚未对这种情况进行广泛的研究。这项研究旨在评估医学难治性TN患者的首次射波刀放射外科（CKRS）治疗的临床结果。
对2009年至2021年在蒙特利尔大学医院中心治疗的166例难治性TN患者（168例手术）进行了回顾性队列研究。使用射波刀进行治疗(G4型，VSI，或M6）。治疗中位最大剂量为80(范围70.0-88.9)Gy。
充分缓解疼痛,使用巴罗神经病学研究所疼痛量表评分(I-IIIb)进行评估，146例（86.9%）。充分缓解疼痛之前的中位潜伏期为35天（范围0-202天）。疼痛复发的患者疼痛缓解的中位持续时间为8.3个月(范围0.6-85.0个月)。从治疗日期起12、36和60个月时保持疼痛缓解的精算率为77.0%，62.5%,50.2%,分别。44例(26.2%)出现面部麻木新发或加重。这种面部麻木预示着疼痛缓解的更好维持(p<0.001)。与多发性硬化症相关的病例相比，特发性病例维持适当的疼痛缓解时间更长（MS;p<0.001）。
在作者的经验中，用于难处理TN的CKRS是高效和安全的。治疗后面部感觉减退的发作或加重预示着疼痛的持续缓解。与MS相关病例相比，特发性病例的疼痛缓解更持久。
对2009年至2021年在蒙特利尔大学医院中心治疗的166例难治性TN患者（168例手术）进行了回顾性队列研究。使用射波刀进行治疗(G4型，VSI，或M6）。治疗中位最大剂量为80(范围70.0-88.9)Gy。
充分缓解疼痛,使用巴罗神经病学研究所疼痛量表评分(I-IIIb)进行评估，146例（86.9%）。充分缓解疼痛之前的中位潜伏期为35天（范围0-202天）。疼痛复发的患者疼痛缓解的中位持续时间为8.3个月(范围0.6-85.0个月)。从治疗日期起12、36和60个月时保持疼痛缓解的精算率为77.0%，62.5%,50.2%,分别。44例(26.2%)出现面部麻木新发或加重。这种面部麻木预示着疼痛缓解的更好维持(p<0.001)。与多发性硬化症相关的病例相比，特发性病例维持适当的疼痛缓解时间更长（MS;p<0.001）。
在作者的经验中，用于难处理TN的CKRS是高效和安全的。治疗后面部感觉减退的发作或加重预示着疼痛的持续缓解。与MS相关病例相比，特发性病例的疼痛缓解更持久。
