Technique of stereotactic medial thalamotomy with the Leksell Gamma Knife for treatment of chronic pain.
Technique of stereotactic medial thalamotomy with the Leksell Gamma Knife for treatment of chronic pain.
复制标题
使用 Leksell 伽玛刀进行立体定向内侧丘脑切除术治疗慢性疼痛的技术。
作者：
R. Young;D. S. Jacques;R. W. Rand;B. Copcutt;Sandra Vermeulen;A. Posewitz
19名患者接受了总共24处内侧丘脑病变，使用Leksell伽玛刀治疗慢性顽固性疼痛，此前广泛的医疗和手术干预未能缓解疼痛。病变位置基于开放式射频内侧丘脑切开术治疗疼痛的既往经验，并针对椎板内、背内侧、正中核和束旁核。所有病变均使用4 mm准直仪头盔，放射外科剂量为140-180 Gray。随访MRI扫描显示解剖学上不同的病变，这些病变在手术后3-6周发生，并在8-12周时完全形成。单个等中心的病变体积平均为300-400 mm 3，两个等中心的病变体积平均为600-900 mm 3，三个等中心的病变体积平均为900-1100 mm 3。1例患者在160 Gray的两个等中心病变后出现体积为5500 mm 3的病变。在15名随访超过3个月（平均随访12个月）的患者中，4名患者（27%）几乎没有疼痛，功能正常，而其他5名患者（33%）的疼痛缓解超过50%。因此，9/15例患者（60%）从伽玛刀内侧丘脑切开术中获益。伽玛刀内侧丘脑切开术产生的丘脑病变大小、形状和位置可靠，并发症发生率低，为某些选定的慢性顽固性疼痛患者提供了微创、经济有效的治疗。
Nineteen patients underwent a total of 24 medial thalamic lesions made with the Leksell Gamma Knife for the treatment of chronic intractable pain after extensive prior medical and surgical intervention had failed to provide pain relief. The lesion locations were based on prior experience with open radiofrequency medial thalamotomies for the treatment of pain and were directed at the intralaminar, mediodorsal, centromedian, and parafascicular nuclei. All lesions were made with the 4 mm collimator helmet at radiosurgical doses from 140-180 Gray. Follow-up MRI scans indicated anatomically distinct lesions which developed 3-6 weeks after the procedure and were fully formed by 8-12 weeks. The lesion volumes averaged 300-400 mm3 for a single isocentre, 600-900 mm3 for two isocentres, and 900-1100 mm3 for three isocentres. One patient developed a lesion 5500 mm3 in volume after a two isocentre lesion at 160 Gray. Of 15 patients who have been followed for more than 3 months (average follow-up 12 months) four patients (27%) are virtually pain free and functioning normally, whereas five other patients (33%) achieved greater than 50% pain relief. Thus 9/15 patients (60%) have had worthwhile benefit from medial thalamotomy with the Gamma Knife. Medial thalamotomy with the Gamma Knife produces thalamic lesions which are reliable in size, shape and location with a low complication rate and offers a minimally invasive, cost effective treatment for certain selected patients with chronic intractable pain.