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Gamma knife radiosurgery (GKRS) for non-cancer refractory pain: early results of a single center series
EANS Academy. Picozzi P. Sep 26, 2019; 276059; EP07026
Dr. Piero Picozzi
Dr. Piero Picozzi

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Abstract
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Objective: Thalamotomy for refractory neuropathic pain is an old procedure with recent revival due to the use of MRgFUS. GKRS has also been used since its origin to target sensory thalamus. We are presenting our initial experience in treating refractory pain with GKRS thalamotomy.
Methods: Between 2015 and 2018 8 patients (4m 4F mean age 47,5; range 43-83) were treated with GKRS for neuropathic pain: 4 patients suffered from neuropathic deafferentation trigeminal pain, 2 from brachial plexus avulsion, 2 from post herpetic neuralgia. All patients were submitted to mono or bilateral central lateral thalamotomy (CLT). 140 Gy at 100% isodose with single 4 mm shot (110° or 90° ) were delivered on the Central Lateral nucleus of the thalamus. All patients were submitted to 4 tests (McGill, EuroQol5D, DN4, SF-36v2) before treatment and at 6, 12 and 24 months follow-up to assess type and intensity of the pain and the impact on quality of life.
Results: Patients complaining pain for brachial plexus avulsion were classified as responders in 1/2 cases, with significant change in the scores at FU. Patients complaining post deafferentation trigeminal pain were classified as responders in 3/4 cases, with significant change in scores and improvement in QOL. Patients suffering from post-herpetic neuralgic syndrome responded in both cases. We classified as 'responders' the ones reporting more than 30% positive change in questionnaire results. No adverse effect was observed in any patient.
Conclusion: In very selected patients Gamma Knife CLT could be a safe therapeutic alternative in refractory non-cancer related refractory pain. Further studies in larger series are required to assess efficacy, safety and durability of the treatment.
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