Search

Objective: Neuropathic pain affects approximately 7-10% of the general population. Its risk tends to rise with age and can impact individuals of any gender. Managing neuropathic pain often requires a combination of strategies. Surgical treatment is considered for patients who fail medical therapy and develop chronic symptoms. The posterior part of the central lateral nucleus (CLp) represents a promising target for the treatment of these cases. We present our experience in using Gamma Knife Surgery (GKS) on the posterior part of the central lateral nucleus (CLp) for refractory neuropathic pain, examining its long-term efficacy and safety in patients with one of the longest pre-treatment pain duration in the literature. Furthermore, we examined certain factors that might influence the outcome of this technique., Methods: We conducted a prospective study involving 9 patients who underwent GKS between 2020 and 2023. We employed Icon model Gamma Knife and Vantage model stereotactic frame. The planning process encompassed a dual localization system. The assessments involved the use of both the Visual Analogue Scale (VAS) and Barrow Neurological Institute (BNI) scales (6,12-month and then, annually). Data analysis was carried out using SPSS25., Results: Our series consisted of 6 women and 3 men with an average age of 52.3±17.4 years.A maximum dose of 130 Gy was administered (eight bilateral, one unilateral).The mid-term postoperative period (1 year) showed that eight patients (88.9%)experienced significant pain relief (VAS p=0.011;BNI I-IIIa).The median follow-up time was 24.8±8.2 (12-37 months). At the last assessment, all patients maintained their improvement (VAS p=0.018;BNI I-II-IIIa/b).We found no association between patient age (p=0.329),duration of pre-treatment pain (p=0.469),multiple previous surgical treatments (p=0.750),or the pain's etiology (p=0.25),and poorer outcomes post CLp thalamotomy.None of the cases has experienced a recurrence so far.Both permanent morbidity and mortality were 0%., Conclusions: Our findings suggest that bilateral ablation of the CLp using GKS is both effective and safe for treating drug-resistant neuropathic pain.This simple,accurate and non-invasive surgical technique effectively achieves pain control across various localized areas and sustains a lasting clinical response,even in patients with multiple previous surgical interventions or prolonged pain duration. These findings encourage us to consider this technique as a highly beneficial strategy for these patients., (Copyright © 2024. Published by Elsevier Inc.)

Background: The initial management of asymptomatic, incidentally discovered, cavernous sinus (CS) meningiomas remains incompletely defined. This study evaluated the safety and efficacy of stereotactic radiosurgery (SRS) for patients presenting with an asymptomatic CS meningioma., Methods: This is an international, retrospective study included patients treated with upfront SRS for an asymptomatic CS meningioma. Local tumor control, tumor and SRS-related complications, and the development of new neurologic deficits after SRS were evaluated., Results: A total of 37 patients (29 men; mean ± SD age: 55.05 ± 11.56 years) treated with upfront SRS for an asymptomatic, CS meningioma were included in the study. The mean ± SD margin dose was 12.27 ± 2.3 Gy. The median clinical and radiological follow-up periods were 66 (IQR 84) and 72 (IQR 84) months, respectively. At the last follow-up, tumor regression and stability were noted in 19 (51.35%) and 18 (48.65%) of CS meningiomas, respectively. SRS-related complications occurred in 2 patients (5.4%) and were managed conservatively., Conclusions: Upfront SRS is a safe and effective treatment option for asymptomatic CS meningiomas. SRS may be considered at the time of initial diagnosis of a CS meningioma. If observation is the initial management chosen, SRS should be recommended when CS meningioma growth is documented on follow-up imaging., (Copyright © 2021 Elsevier Inc. All rights reserved.)