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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2019; 77(04): 232-238
DOI: 10.1590/0004-282X20190027
Article

Gamma knife radiosurgery for trigeminal neuralgia: first case series from Latin America

Radiocirurgia por gamma knife para tratamento da neuralgia do trigêmeo: primeira série de casos na América Latina
Felipe Constanzo 
1   Instituto de Neurologia de Curitiba, Departamento de Neurocirurgia, Curitiba PR, Brasil
,
Rodrigo Souza da Silva
2   Instituto de Neurologia de Curitiba, Departamento de Anestesiologia, Curitiba PR, Brasil
,
Daniel Benzecry de Almeida
1   Instituto de Neurologia de Curitiba, Departamento de Neurocirurgia, Curitiba PR, Brasil
3   Instituto de Neurologia de Curitiba, Departamento de Gamma Knife, Curitiba PR, Brasil
,
Maria Alice Ferragut
3   Instituto de Neurologia de Curitiba, Departamento de Gamma Knife, Curitiba PR, Brasil
,
Mauricio Coelho Neto
1   Instituto de Neurologia de Curitiba, Departamento de Neurocirurgia, Curitiba PR, Brasil
3   Instituto de Neurologia de Curitiba, Departamento de Gamma Knife, Curitiba PR, Brasil
,
Hugo Veroneze Toledo
3   Instituto de Neurologia de Curitiba, Departamento de Gamma Knife, Curitiba PR, Brasil
4   Clínica Paranaense de Tumores, Curitiba PR, Brasil
,
Ricardo Ramina
1   Instituto de Neurologia de Curitiba, Departamento de Neurocirurgia, Curitiba PR, Brasil
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ABSTRACT

Gamma Knife® radiosurgery (GKRS) for trigeminal neuralgia is an effective treatment with at least a 50% reduction of pain in 75-95% of patients.

Objective: To present the first series of patients treated for trigeminal neuralgia using GKRS in Latin America.

Methods: Retrospective analysis. Analysis consisted of time to improvement of symptoms, best Barrow Neurological Institute scale (BNI) score after procedure, time without pain, time to recurrence and post-procedural hypoesthesia.

Results: Nineteen cases of classical trigeminal neuralgia were analyzed and three cases of symptomatic trigeminal neuralgia were described. Mean time from symptom onset to radiosurgery was 99.6 months, and 78.9% of patients had undergone invasive procedures before treatment. Patients were followed for a mean of 21.7 months. BNI I was achieved in 36.8%, IIIa in 21.1%, IIIb in 21.1%, IV in 5.3% and V in 15.7%. New hypoesthesia developed in 12.1% patients, which was associated with achieving BNI I after the procedure (p < 0.05). Time from diagnosis to GKRS was higher in patients who failed to achieve BNI I (143 vs. 76 months). The distance from the root entry zone in patients who achieved BNI I was greater than patients who did not (1.94 vs. 1.14 mm). Mean distance from the root entry zone in patients with new hypoesthesia was 2.85 mm vs. 1.06 mm (p = 0.06).

Conclusion: Clinical response to GKRS is related to the time between diagnosis and procedure, thus its indication should be considered early in the management of these patients.

RESUMO

A radiocirurgia por Gamma Knife (GKRS) para neuralgia do trigêmeo é um tratamento comprovado, com redução de pelo menos 50% da dor em 75-95% dos casos.

Objetivo: Apresentar a primeira série de pacientes tratados por neuralgia do trigêmeo com GKRS na America Latina.

Métodos: Análise retrospectiva. A análise consistiu no tempo até melhora do sintoma, melhor escala do Barrow Neurological Institute (BNI) depois do procedimento, tempo sem dor, tempo até recorrência e hipoestesia pós-procedimento.

Resultados: Dezenove casos de neuralgia do trigêmeo clássica foram analisados e três casos de neuralgia do trigêmeo sintomática foram descritos. Tempo médio entre começo dos sintomas e GKRS foi de 99,6 meses e 78,9% dos pacientes já tinham sido submetidos a procedimento invasivo prévio. O tempo de acompanhamento médio foi de 21,7 meses. BNI I foi conseguido em 36,8%, IIIa em 21,1%, IIIb em 21,1%, IV em 5,3% e V em 15,7%. Nova hipoestesia apareceu em 12,1% dos casos, o que foi associado a conseguir BNI I pós-procedimento (p < 0,05). Tempo desde o diagnóstico até GKRS foi maior em pacientes que não conseguiram BNI I (143 vs. 76 meses). Distância da zona de entrada do nervo em pacientes que conseguiram BNI I foi maior (1,94 vs. 1,14mm). Distância do zona de entrada do nervo em pacientes com nova hipoestesia foi de 2,85mm vs. 1,06mm (p = 0,06)

Conclusão: A resposta à GKRS está relacionada ao tempo entre diagnóstico e procedimento, pelo que a indicação de GKRS deve ser considerada cedo no tratamento desses pacientes.

Keywords:

Trigeminal neuralgia - radiosurgery - neuropathic pain

Palavras-chave:

Neuralgia do trigêmeo - radiocirurgia - neuralgia


Publication History

Received: 15 September 2018

Accepted: 21 December 2018

Article published online:
16 August 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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