Gamma Knife radiosurgery for glossopharyngeal neuralgia: A study of 21 patients with long-term follow-up.

Details

Serval ID
serval:BIB_66E5E92657CC
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Gamma Knife radiosurgery for glossopharyngeal neuralgia: A study of 21 patients with long-term follow-up.
Journal
Cephalalgia
Author(s)
Borius P.Y., Tuleasca C., Muraciole X., Negretti L., Schiappacasse L., Dorenlot A., Marguet M., Zeverino M., Donnet A., Levivier M., Regis J.
ISSN
1468-2982 (Electronic)
ISSN-L
0333-1024
Publication state
Published
Issued date
03/2018
Peer-reviewed
Oui
Volume
38
Number
3
Pages
543-550
Language
english
Notes
Publication types: Clinical Study ; Journal Article ; Multicenter Study
Publication Status: ppublish
Abstract
Objective Glossopharyngeal neuralgia (GPN) is a very rare condition, affecting the patient's quality of life. We report our experience in drug-resistant, idiopathic GPN, treated with Gamma Knife radiosurgery (GKRS), in terms of safety and efficiency, on a very long-term basis. Methods The study was opened, self-controlled, non-comparative and bicentric (Marseille and Lausanne University Hospitals). Patients treated with GKRS between 2003 and 2015 (models C, 4C and Perfexion) were included. A single 4-mm isocentre was positioned in the cisternal portion of the glossopharyngeal nerve, with a targeting based both on magnetic resonance imaging (MRI) and computed tomography (CT). The mean maximal dose delivered was 81.4 ± 6.7 Gy (median = 85 Gy, range = 60-90 Gy at the 100% isodose line). Results Twenty-one patients (11 women, 10 men) benefited from 25 procedures. The mean follow-up period was 5.2 ± 3 years (range = 0.9-12.1 years). Seventeen (81%) were initially pain-free after GKRS. At three months, six months and one year after radiosurgery, the percentage of patients with good outcome (BNI classes I to IIIA) was 87.6%, 100% and 81.8%, respectively. Ten cases (58.8%) from the initial pain-free ones had a recurrence, after a mean period of 13.6 ± 10.4 months (range = 3.1-36.6 months). Only three patients (14.2%) had recurrences (two for each one of them) requiring further surgeries. Three patients underwent a second GKRS procedure; one case needed a third GKRS. The former procedures were performed at 7, 17, 19 and 30 months after the first one, respectively. Furthermore, two patients needed additional interventions. At last follow-up, 17 cases (80.9%) were still pain-free without medication. The actuarial pain relief without new surgery was 83%. A transient complication (paraesthesia of the edge of the tongue) was seen in one case (4.8%). Conclusion GKRS is a valuable, minimally invasive, surgical alternative for idiopathic GPN, with a very high short- and long-term efficacy and without permanent complications. A quality imaging, including T2 CISS/Fiesta MRI and bone CT acquisitions for good visualisation of the nerve and the other bony anatomic landmarks, is essential for targeting accuracy and successful therapy.
Keywords
Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Glossopharyngeal Nerve Diseases/surgery, Humans, Male, Middle Aged, Radiosurgery/methods, Time, Treatment Outcome, Gamma Knife radiosurgery, Pain, glossopharyngeal neuralgia, radiosurgery
Pubmed
Web of science
Create date
05/10/2017 14:38
Last modification date
20/08/2019 15:22
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