Medial Gamma Knife thalamotomy for intractable pain

Result code in IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00023884%3A_____%2F18%3A00007888" target="_blank" >RIV/00023884:_____/18:00007888 - isvavai.cz</a>

Result on the web

<a href="http://dx.doi.org/10.3171/2018.7.GKS181583" target="_blank" >http://dx.doi.org/10.3171/2018.7.GKS181583</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.3171/2018.7.GKS181583" target="_blank" >10.3171/2018.7.GKS181583</a>

Result language

angličtina

Original language name

Medial Gamma Knife thalamotomy for intractable pain

Original language description

OBJECTIVE Ablative procedures are still useful in the treatment of intractable pain despite the proliferation of neuromodulation techniques. In the paper the authors present the results of Gamma Knife thalamotomy (GKT) in various pain syndromes. METHODS Between 1996 and 2016, unilateral GKT was performed in 30 patients suffering from various severe pain syndromes in whom conservative treatment had failed. There were 20 women and 10 men in the study population, with a median age of 80 years (range 53–89 years). The pain syndromes consisted of 8 patients with classic treatmentresistant trigeminal neuralgia (TN), 6 with postherpetic TN, 5 with TN and constant pain, 1 with TN related to multiple sclerosis, 3 with trigeminal neuropathic pain, 4 with thalamic pain, 1 with phantom pain, 1 with causalgic pain, and 1 with facial pain. The median follow-up period was 24 months (range 12–180 months). Invasive procedures for pain release preceded GKT in 20 patients (microvascular decompression, glycerol rhizotomy, balloon microcompression, Gamma Knife irradiation of the trigeminal root, and radiofrequency thermolesion). The Leksell stereotactic frame, GammaPlan software, and T1- and T2-weighted sequences acquired at 1.5 T were used for localization of the targeted medial thalamus, namely the centromedian (CM) and parafascicularis (Pf) nucleus. The CM/Pf complex was localized 4–6 mm lateral to the wall of the third ventricle, 8 mm posterior to the midpoint, and 2–3 mm superior to the intercommissural line. GKT was performed using the Leksell Gamma Knife with an applied dose ranging from 145 to 150 Gy, with a single shot, 4-mm collimator. Pain relief after radiation treatment was evaluated. Decreased pain intensity to less than 50% of the previous level was considered successful. RESULTS Initial successful results were achieved in 13 (43.3%) of the patients, with complete pain relief in 1 of these patients. Relief was achieved after a median latency of 3 months (range 2–12 months). Pain recurred in 4 (31%) of 13 patients after a median latent interval of 24 months (range 22–30 months). No neurological deficits were observed. CONCLUSIONS These results suggest that GKT in patients suffering from severe pain syndromes is a relatively successful and safe method that can be used even in severely affected patients. The only risk of GT for the patients in this study was failure of treatment, as no clinical side effects were observed

Czech name

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Czech description

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Type

J_imp - Article in a specialist periodical, which is included in the Web of Science database

CEP classification

—

OECD FORD branch

30103 - Neurosciences (including psychophysiology)

Project

—

Continuities

I - Institucionalni podpora na dlouhodoby koncepcni rozvoj vyzkumne organizace

Publication year

2018

Confidentiality

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Name of the periodical

Journal of Neurosurgery

ISSN

0022-3085

e-ISSN

—

Volume of the periodical

129

Issue of the periodical within the volume

Suppl. 1

Country of publishing house

US - UNITED STATES

Number of pages

5

Pages from-to

72-76

UT code for WoS article

000453374900012

EID of the result in the Scopus database

2-s2.0-85057729189