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

Détails

ID Serval
serval:BIB_66E5E92657CC
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Gamma Knife radiosurgery for glossopharyngeal neuralgia: A study of 21 patients with long-term follow-up.
Périodique
Cephalalgia
Auteur(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
Statut éditorial
Publié
Date de publication
03/2018
Peer-reviewed
Oui
Volume
38
Numéro
3
Pages
543-550
Langue
anglais
Notes
Publication types: Clinical Study ; Journal Article ; Multicenter Study
Publication Status: ppublish
Résumé
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.
Mots-clé
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
Création de la notice
05/10/2017 13:38
Dernière modification de la notice
20/08/2019 14:22
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