PDF(Pubmed)
Abstract：
UNASSIGNED: Frameless image-guided radiosurgery (IGRS) is an effective and non-invasive method of treating patients who are unresponsive to medical management for trigeminal neuralgia (TN). This study evaluated the use of frameless IGRS to treat patients with medically refractory TN.
UNASSIGNED: We performed a retrospective review of records of 116 patients diagnosed with TN who underwent frameless IGRS using a linear accelerator (LINAC) over 10 years (March 2012-February 2023). All patients had failed medical management for TN. Facial pain was graded using the Barrow Neurological Institute (BNI) scoring system. Each patient received a BNI score before frameless IGRS and following treatment. Failure was defined as a BNI score IV-V at the last follow-up and/or undergoing a salvage procedure following IGRS.
UNASSIGNED: All patients had a BNI score of either IV or V before the frameless IGRS. The mean follow-up duration for all 116 patients following IGRS was 44.1 months. Most patients (81 [69.8%]) had not undergone surgery (microvascular decompression [MVD] or rhizotomy) or stereotactic radiosurgery (SRS) for TN before frameless IGRS. A total of 41 (35.3%) patients underwent a salvage procedure (MVD, rhizotomy, or an additional IGRS) following frameless IGRS. The mean duration between the initial frameless IGRS and salvage procedure was 20.1 months. At the last follow-up, a total of 110 (94.8%) patients had a BNI score of I-III. No complications were reported after the frameless IGRS. The BNI score at the last follow-up was lower compared to the initial BNI for patients regardless of prior intervention (P < 0.001). Patients who failed IGRS had a higher BNI score at the last follow-up compared to those who did not fail IGRS (2.8 vs. 2.5, P = 0.05). Patients with pain relief had a shorter follow-up compared to those with pain refractory to SRS (38.0 vs. 55.1, P = 0.005).
UNASSIGNED: In this large cohort of patients with medically refractory TN, frameless IGRS resulted in durable pain control in the majority of patients without any toxicity.
UNASSIGNED: We performed a retrospective review of records of 116 patients diagnosed with TN who underwent frameless IGRS using a linear accelerator (LINAC) over 10 years (March 2012-February 2023). All patients had failed medical management for TN. Facial pain was graded using the Barrow Neurological Institute (BNI) scoring system. Each patient received a BNI score before frameless IGRS and following treatment. Failure was defined as a BNI score IV-V at the last follow-up and/or undergoing a salvage procedure following IGRS.
UNASSIGNED: All patients had a BNI score of either IV or V before the frameless IGRS. The mean follow-up duration for all 116 patients following IGRS was 44.1 months. Most patients (81 [69.8%]) had not undergone surgery (microvascular decompression [MVD] or rhizotomy) or stereotactic radiosurgery (SRS) for TN before frameless IGRS. A total of 41 (35.3%) patients underwent a salvage procedure (MVD, rhizotomy, or an additional IGRS) following frameless IGRS. The mean duration between the initial frameless IGRS and salvage procedure was 20.1 months. At the last follow-up, a total of 110 (94.8%) patients had a BNI score of I-III. No complications were reported after the frameless IGRS. The BNI score at the last follow-up was lower compared to the initial BNI for patients regardless of prior intervention (P < 0.001). Patients who failed IGRS had a higher BNI score at the last follow-up compared to those who did not fail IGRS (2.8 vs. 2.5, P = 0.05). Patients with pain relief had a shorter follow-up compared to those with pain refractory to SRS (38.0 vs. 55.1, P = 0.005).
UNASSIGNED: In this large cohort of patients with medically refractory TN, frameless IGRS resulted in durable pain control in the majority of patients without any toxicity.
摘要：
■无框架图像引导放射外科（IGRS）是一种有效且无创的方法，可治疗对三叉神经痛（TN）的医疗管理无反应的患者。这项研究评估了无框IGRS在治疗难治性TN患者中的应用。
■我们对116例诊断为TN的患者的记录进行了回顾性审查，这些患者使用线性加速器（LINAC）进行了10年（2012年3月至2023年2月）的无框IGRS。所有患者的TN医疗管理失败。使用巴罗神经研究所（BNI）评分系统对面部疼痛进行评分。每位患者在无框IGRS之前和治疗后接受BNI评分。失败定义为在最后一次随访和/或在IGRS后接受抢救程序时的BNI评分IV-V。
■所有患者在无框IGRS之前的BNI评分为IV或V。所有116例IGRS患者的平均随访时间为44.1个月。大多数患者（81[69.8％]）在无框IGRS之前没有接受过TN手术（微血管减压术[MVD]或根际切开术）或立体定向放射外科（SRS）。共有41例(35.3%)患者接受了抢救程序(MVD，根际切断术,或额外的IGRS)跟随无框IGRS。初始无框IGRS和救助程序之间的平均持续时间为20.1个月。在最后一次随访中，共有110例(94.8%)患者的BNI评分为I-III.无框IGRS术后无并发症报告。与患者的初始BNI相比，末次随访时的BNI评分较低（P<0.001）。与IGRS未失败的患者相比，IGRS失败的患者在最后一次随访中的BNI评分更高（2.8vs.2.5,P=0.05)。与疼痛难治的SRS患者相比，疼痛缓解患者的随访时间较短（38.0vs.55.1,P=0.005)。
■在这个庞大的医学难治性TN患者队列中，无框IGRS可在大多数患者中实现持久的疼痛控制,无任何毒性.
■我们对116例诊断为TN的患者的记录进行了回顾性审查，这些患者使用线性加速器（LINAC）进行了10年（2012年3月至2023年2月）的无框IGRS。所有患者的TN医疗管理失败。使用巴罗神经研究所（BNI）评分系统对面部疼痛进行评分。每位患者在无框IGRS之前和治疗后接受BNI评分。失败定义为在最后一次随访和/或在IGRS后接受抢救程序时的BNI评分IV-V。
■所有患者在无框IGRS之前的BNI评分为IV或V。所有116例IGRS患者的平均随访时间为44.1个月。大多数患者（81[69.8％]）在无框IGRS之前没有接受过TN手术（微血管减压术[MVD]或根际切开术）或立体定向放射外科（SRS）。共有41例(35.3%)患者接受了抢救程序(MVD，根际切断术,或额外的IGRS)跟随无框IGRS。初始无框IGRS和救助程序之间的平均持续时间为20.1个月。在最后一次随访中，共有110例(94.8%)患者的BNI评分为I-III.无框IGRS术后无并发症报告。与患者的初始BNI相比，末次随访时的BNI评分较低（P<0.001）。与IGRS未失败的患者相比，IGRS失败的患者在最后一次随访中的BNI评分更高（2.8vs.2.5,P=0.05)。与疼痛难治的SRS患者相比，疼痛缓解患者的随访时间较短（38.0vs.55.1,P=0.005)。
■在这个庞大的医学难治性TN患者队列中，无框IGRS可在大多数患者中实现持久的疼痛控制,无任何毒性.
