Analysis of Efficacy and Prognosis of Gamma Knife in the Treatment of Primary Trigeminal Neuralgia in the Elderly

Abstract

Abstract: Objective The differences in curative effect, recurrence rate and complications of gamma knife(GKS) in elderly patients with primary trigeminal neuralgia (PTN) were retrospectively analyzed. Methods The medical records of PTN patients who were treated with GKS in the Gamma knife Center of the Fifth affiliated Hospital of Zhengzhou University from January 2017 to April 2020 were collected and divided into elderly group (≥70 years old) and middle-aged group (<60 years old). The data of postoperative curative effect, recurrence and related complications were collected by telephone and outpatient follow-up and the differences were analyzed. Results The effective rate of postoperative pain relief in the elderly group was higher than that in the middle-aged group (P<0.05). The recurrence rate in the elderly group was lower than that in the middle-aged group (P<0.05). The recurrence rate in the middle-aged-TN1 group was significantly lower than that in the middle-aged-TN1 group. The occurrence of facial numbness in the elderly group was later than that in the middle-aged group (P<0.05). Conclusion Compared with middle-aged people, gamma knife can provide better pain relief for elderly patients with PTN, and the risk of recurrence is lower. Gamma knife is a good alternative therapy for elderly PTN patients with high surgical risk.

Key words: gamma knife, primary trigeminal neuralgia, elderly patients, clinical curative effect, complication, relapse rate

CLC Number:

R454.9

CHEN Guan-qi, GUO Yong-kun, LIU Wan-qing, MAO Jian-chao, ZHANG Qing-zhu, SHAN Qiao. Analysis of Efficacy and Prognosis of Gamma Knife in the Treatment of Primary Trigeminal Neuralgia in the Elderly[J]. ZHONGHUA YANGSHENG BAOJIAN, 2023, 41(22): 44-48.

References

[1] Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition[J]. Cephalalgia, 2018,38(1):1-211.
[2] BENDTSEN L, ZAKRZEWSKA J M, HEINSKOU T B, et al.Advances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgia[J]. Lancet Neurol, 2020,19(9):784-796.
[3] ELLER J L, RASLAN A M, BURCHIEL K J.Trigeminal neuralgia: definition and classification[J]. Neurosurg Focus, 2005,18(5):E3.
[4] 刘清军. 《三叉神经痛诊疗中国专家共识》解读[J].中国现代神经疾病杂志, 2018,18(9):643-646.
[5] BENNETTO L, PATEL N K, FULLER G.Trigeminal neuralgia and its management[J]. BMJ, 2007,334(7586):201-205.
[6] HARDAWAY F A, GUSTAFSSON H C, HOLSTE K, et al.A novel scoring system as a preoperative predictor for pain-free survival after microsurgery for trigeminal neuralgia[J]. J Neurosurg,2020,132(1):217-224.
[7] JO K W, KONG D S, HONG K S, et al.Long-term prognostic factors for microvascular decompression for trigeminal neuralgia[J]. J Clin Neurosci,2013,20(3):440-445.
[8] LEAL P R, HERMIER M, FROMENT J C, et al.Preoperative demonstration of the neurovascular compression characteristics with special emphasis on the degree of compression, using high-resolution magnetic resonance imaging:a prospective study, with comparison to surgical findings, in 100 consecutive patients who underwent microvascular decompression for trigeminal neuralgia[J]. Acta Neurochir (Wien), 2010,152(5):817-825.
[9] FARISELLI L, MARRAS C, DE SANTIS M, et al.CyberKnife radiosurgery as a first treatment for idiopathic trigeminal neuralgia[J].Neurosurgery,2009,64(2 Suppl):A96-A101.
[10] PEDDADA A V, SCEATS D J, WHITE G A, et al.CyberKnife radiosurgery for trigeminal neuralgia: unanticipated iatrogenic effect following successful treatment[J]. J Neurosurg, 2011,115(5):940-944.
[11] ATTIA A, TATTER S B, WELLER M, et al.CT-only planning for Gamma Knife radiosurgery in the treatment of trigeminal neuralgia:methodology and outcomes from a single institution[J]. J Med Imaging Radiat Oncol, 2012,56(4):490-494.
[12] AZAR M, YAHYAVI S T, BITARAF M A, et al.Gamma knife radiosurgery in patients with trigeminal neuralgia:quality of life,outcomes,and complications[J]. Clin Neurol Neurosurg, 2009,111(2):174-178.
[13] DOS S M, PEREZ D S J, GUTIERREZ D J, et al. Outcome for patients with essential trigeminal neuralgia treated with linear accelerator stereotactic radiosurgery[J]. Stereotact Funct Neurosurg, 2011,89(4):220-225.
[14] LIM M, COTRUTZ C, ROMANELLI P, et al.Stereotactic radiosurgery using CT cisternography and non-isocentric planning for the treatment of trigeminal neuralgia[J]. Comput Aided Surg, 2006,11(1):11-20.
[15] SATO D, HAYASHI M, HORIBA A, et al.Long-Term Results of Gamma Knife Radiosurgery for Trigeminal Neuralgia[J]. World Neurosurg, 2023,171:e787-e791.
[16] KONDZIOLKA D, ZORRO O, LOBATO-POLO J, et al.Gamma Knife stereotactic radiosurgery for idiopathic trigeminal neuralgia[J]. Journal of neurosurgery,2010,112(4):758.
[17] BARZAGHI L R, ALBANO L, SCUDIERI C, et al.Factors affecting long-lasting pain relief after Gamma Knife radiosurgery for trigeminal neuralgia:a single institutional analysis and literature review[J]. Neurosurg Rev,2021,44(5):2797-2808.
[18] AL-QULITI K W. Update on neuropathic pain treatment for trigeminal neuralgia. The pharmacological and surgical options[J]. Neurosciences (Riyadh), 2015,20(2):107-114.
[19] HENSON C F, GOLDMAN H W, ROSENWASSER R H, et al.Glycerol rhizotomy versus gamma knife radiosurgery for the treatment of trigeminal neuralgia: an analysis of patients treated at one institution[J]. Int J Radiat Oncol Biol Phys,2005,63(1):82-90.
[20] ZHAO Z, CHAI S, WANG J, et al.Comparison of Microvascular Decompression and Two Isocenters Gamma Knife for the Treatment of Trigeminal Neuralgia Caused by Vertebrobasilar Dolichoectasia[J]. Front Neurol,2021,12:707985.
[21] KERIC N, KALASAUSKAS D, KRETH S L, et al.An age-dependent outcome analysis of microvascular decompression and percutaneous thermocoagulation in trigeminal neuralgia[J]. BMC Neurol, 2021,21(1):182.
[22] LOVE S, COAKHAM H B.Trigeminal neuralgia: pathology and pathogenesis[J]. Brain,2001,124(Pt 12):2347-2360.