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The Evaluation of Targeting Retrogassarian versus Root Entry Zone in Gamma Knife Radiosurgery for Trigeminal Neuralgia

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 3, Pages 263-268
10.52573/ipmj.2021.175758

Abstract

BACKGROUND: 
The advantage of gamma knife radiosurgery is lack of major side effects. It is preferred over microvascular decompression in elderly patients who are poor candidates for general anesthesia or those unwilling to undergo an open neurosurgical procedure.
PATIENTS AND METHODS:
This is a comparative study conducted at Dr. Saad Alwitry Neuroscience Hospital, Gamma Knife Department. 20 patients were included in the study, divided into 2 groups in which 10 are treated with dorsal root entry zone DREZ and the another 10 treated with retrogasserian RG, starting from July 2019 to March 2020. The new target (retrogasserian zone) was targeted for the first time in Iraq, were compared to those patients treated with root entry zone as their target. The follow up time was 4 months. The DREZ target received 80 Gray in 50% isodose, while the RG target received 90 Gray in 50% isodose.
RESULTS:
The mean age is 54.3 years for DREZ and 59 years for RG, most of the treated patients are female with male to female ratio 2.2-1, pain intensity was assessed by BNI scale pre and post Gamma Knife that targeted both DREZ and RG, pain intensity with DREZ, mean improvement is 3.2. Pain is significantly improved.
Pain intensity with RG, mean improvement is 3.2, pain is significantly improved. Pain frequency was less in postGK for both the DREZ & RG with mild superiority in the RG.
CONCLUSION:
GK is considered as being both a safe and effective procedure to treat medically resistant trigeminal neuralgia. GK is the least invasive procedure in treating medically resistant trigeminal neuralgia MRTN, with the least and less serious complications. GK targets (DREZ & RG) both can achieve a good pain control with decrease in medication and improving overall life quality. RG target shows slight further reduction in pain frequency than DREZ.
 
Keywords:

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