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KMID : 1150120200060010008
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Asian Journal of Pain
2020 Volume.6 No. 1 p.8 ~ p.13
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Effect of Cyberknife Radiosurgery for Elderly Patients with Trigeminal Neuralgia
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Lee Dong-Eon
Kim Min-Soo
Ahn Jong-Ho
Jang Seu-Ryang
Lee Eun-Hye
Lee Min-Ho
Shin Jae-Jeon
Lee Sang-Bok
Kim Young-Woo
Ji Chul
Lee Tae-Kyu
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Abstract
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Objective: We retrospectively analyzed the outcome of 28 patients over 65 years old with medically intractable Trigeminal Neuralgia (TN) to evaluate whether CyberKnife RadioSurgery (CKRS) is an effective and safe modality of therapy.
Methods: We collect retrospective data on 28 patients undergoing CKRS in patients with TN since April 1, 2004. We performed CKRS to treat TN in older patients. And a Computed Tomography (CT) cisternography obtained a distortion-free localization of the trigeminal nerve. The treatment target was to designate a 3-5 mm proximal region's trigeminal nerve, excluding the REZ of the trigeminal nerve in the brain stem. We set treatment planning that the radiation targets could be included in the 80-percent isodose curve with radiosurgery doses of 60-64 Gy. The median follow-up period after CKRS was 36 months (24-48 months). Pain intensity was measured using a Visual Analog Scale (VAS), Quality of Life Scale (QOLS) were measured at baseline and after CKRS.
Results: Relief of pain in 28 patients with TN after CKRS showed that pain relief was achieved in 15 patients within the first 24 hours after CKRS. Within 7 days, 25 of the 28 study patients reported early pain relief. The pain control rate was 85.7% at follow up of 24 months. Pain relapsed in four of 28 patients. Twelve patients had hyperesthesia (35.7%) with no other complication. The mean (±S.D.) VAS of baseline status was 7.7 (±0.97) before CKRS in patients with TN. VAS decreased to 3.6±1.8 within 24 hours after CKRS compared with baseline VAS. The relief of pain was sustained by 2.1±1.5 for 1 week and by 1.8±1.7 at 6 months. After 12 months and 24 months, VAS remained by 2.0±1.4 and 2.1±1.5. The dose of gabapentin (1,200±600 mg/day) before treatment. The gabapentin dose in the six month did not significantly decrease in taking gabapentin (900±300 mg/day) compared with the baseline dose. Consumption after 24 months was also significantly reduced by 600±300 mg/day.
Conclusion: We conclude that CKRS is a safe and effective treatment for elderly patients with TN in this study. In most patients, the pain was relieved in seven days after CKRS, and no severe complications occurred. However, in older patients, CKRS could be considered as a treatment option for TN.
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KEYWORD
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CKRS, Cyberknife Radiosurgery, Trigeminal Neuralgia
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