neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2019-21-3-11-20neurosurgery-741Research ArticleОРИГИНАЛЬНАЯ РАБОТАORIGINAL REPORTРадиохирургическое лечение тригеминальной невралгии: опыт центра радиохирургии Научно-исследовательского института скорой помощи им. Н.В. СклифосовскогоRadiosurgical treatment of trigeminal neuralgia: experience of the Radiosurgery Center of the N.V. Sklifosovsky Research Institute for Emergency Medicinehttps://orcid.org/0000-0002-8415-5602ТокаревА. C.TokarevA. S.

Алексей Сергеевич Токарев

mail@rssklif.ruhttps://orcid.org/0000-0001-5026-0060СинкинМ. В.SinkinM. V.https://orcid.org/0000-0003-0521-4836РожноваЕ. Н.RozhnovaE. N.https://orcid.org/0000-0003-0007-8054СтепановВ. Н.StepanovV. N.https://orcid.org/0000-0002-4534-8719РакВ. А.RakV. A.ГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского Департамента здравоохранения г. Москвы»РоссияN.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare DepartmentRussian Federation2019140920192131220Copyright © Токарев А.C., Синкин М.В., Рожнова Е.Н., Степанов В.Н., Рак В.А., 20192019Токарев А.C., Синкин М.В., Рожнова Е.Н., Степанов В.Н., Рак В.А.Tokarev A.S., Sinkin M.V., Rozhnova E.N., Stepanov V.N., Rak V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/741

Цель исследования – оценка ранних результатов радиохирургического лечения (РХЛ) фармакорезистентной тригеминальной невралгии (ТН) различной этиологии.

Материалы и методы

Материалы и методы. В центре радиохирургии Научно-исследовательского института скорой помощи им. Н.В. Склифосовского с 01.01.2016 по 01.07.2018 проведено РХЛ 14 пациентов с фармакорезистентным течением ТН. По данным магнитно-резонансной томографии у 7 пациентов до лечения был выявлен нейроваскулярный конфликт, у 2 – демиелинизация корешка тройничного нерва вследствие рассеянного склероза, а у 5 пациентов патологии головного мозга не обнаружено. Проведено облучение цистернальной порции тройничного нерва на расстоянии 7,5 мм от места выхода из ствола мозга с предписанной дозой (ПД) до 90 Гр. Период наблюдения за больными составил 8–20 мес. Оценивали разницу фракционной анизотропии (ФА) на пораженной и здоровой сторонах у пациентов с ТН до проведения РХЛ, распределяя их по 2 группам: с выраженным снижением ФА и с умеренным снижением.

Результаты

Результаты. Все пациенты, прошедшие РХЛ с ПД >80 Гр (85,7 %), отметили уменьшение интенсивности боли или ее полное исчезновение. У 11 (78,5 %) пациентов обезболивающий эффект проявился спустя 3–6 нед после РХЛ, у 1 – через 3 мес. Полное купирование болевого синдрома произошло у больного с идиопатической ТН II типа (ПД 84 Гр) через 3 мес после РХЛ, у пациента с нейроваскулярным конфликтом и ТН I типа (ПД 86 Гр) – через 6 нед, у больного с рассеянным склерозом и ТН I типа (ПД 81 Гр) – через 3 нед. У последнего через 12 мес после РХЛ боль вернулась, но с меньшей интенсивностью. У 2 (14,3 %) пациентов (ПД 80 Гр) за 6 мес наблюдения положительный эффект не наступил. Гипестезия участка лица (осложнение РХЛ) диагностирована лишь у 1 (7,2 %) пациента спустя 8 мес после РХЛ и сохранялась на протяжении 6 нед, постепенно регрессируя. Статистически значимой корреляции между снижением ФА и исходом РХЛ не выявлено, однако отмечено, что исход был более благоприятным у пациентов с умеренным снижением ФА.

Заключение

Заключение. РХЛ фармакорезистентных форм ТН с ПД >80 Гр значительно уменьшает выраженность болевого синдрома через 3–6 нед и более и характеризуется низким риском развития осложнений.

The study objective is to evaluate early results of radiosurgical treatment (RST) of drug-resistant trigeminal neuralgia (TN) of various etiology.

Materials and methods

Materials and methods. Between 01.01.2016 and 01.07.2018 at the Radiosurgery Center of the N.V. Sklifosovsky Research Institute for Emergency Medicine, 14 patients with drug-resistant TN underwent RST. Per magnetic resonance imaging, prior to treatment 7 patients had neurovascular conflict, 2 had demyelination of the root of the trigeminal nerve due to multiple sclerosis, and 5 patients showed no pathologies of the brain. Irradiation of the cisternal portion of the trigeminal nerve at the distance of 7.5 mm from the entry into the brainstem with prescribed dose of 90 Gy was performed. Follow-up period was 8–20 months. The difference in fractional anisotropy (FA) at the affected and healthy sides was evaluated in patients with TN prior to RST to divide them into 2 groups: with significant FA decrease and with moderate FA decrease.

Results

Results. All patients who underwent RST with PD >80 Gy (85.7 %) noted decreased level of pain or its full disappearance. In 11 (78.5 %) patients, anesthetic effect manifested itself 3–6 weeks after RST, in 1–3 months after RST. Full analgesic effect was achieved in a patient with idiopathic type II TN (PD 84 Gy) 3 months after RST, in a patient with neurovascular conflict and type I TN (PD 86 Gy) 6 weeks after RST, in a patient with multiple sclerosis and type I TN (PD 81 Gy) 3 weeks after RST. In the last-mentioned patient, pain returned 12 months after RST but with lower intensity. In 2 (14.3 %) patients (PD 80 Gy), no positive effect was observed in 6 months of follow up. Hypesthesia of a face area (RST complication) was diagnosed in only 1 (7.2 %) patient 8 months after RST, and it persisted for 6 weeks gradually regressing. There was no statistically significant correlation between FA decrease and RST outcome, but it was observed that outcome was more favorable in patients with moderately decreased FA.

Conclusion

Conclusion. RST of drug-resistant forms of TN with PD >80 Gy significantly reduces pain syndrome 3–6 weeks after treatment and is characterized by low risk of complications.

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The authors declare that there are no conflicts of interest present.