Plenary Oral Presentations - Macquarie University Hospital

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16 th International Meeting of the Leksell Gamma Knife ® SocietyMarch 2012, Sydney, AustraliaFU-231Gamma knife thalamotomy for Parkinson’sdisease and essential tremor: A prospectivemulti-institutinal study in Japan1Yoshinori Higuchi, 2 Chihiro Ohye, 2 Toru Shibazaki, 3 Takao Hashimoto, 3 Toru Koyama,4Tatsuo Hirai, 5 Shinji Matsuda, 6 Toru Serizawa, 7 Tomokatsu Hori, 7 Motohiro Hayashi,7Taku Ochiai, 8 Hirofumi Samura, 8 Katsumi Yamashiro1Department of Neurological Surgery, Chiba University Graduate School of Medicine2Functional and Gamma Knife Surgery Center, Hidaka Hospital, Takasaki, Japan3Center for Neurological Diseases, Aizawa Hospital, Matsumoto, Japan4Gamma Knife Center, Heisei Memorial Hospital, Fujieda, Japan5Gamma Knife House, Chiba Cardiovascular Center, Ichihara, Japan6Tokyo Gamma Unit Center, Tsukiji Neurological Clinic, Tokyo, Japan7Department of Neurosurgery, Tokyo Womenâ€s Medical University, Tokyo, Japan8Department of Neurosurgery, Okinawa Central Hospital, Naha, JapanObjective: No prospective study of gamma knife thalamotomy for intractable tremor has previouslybeen reported. To clarify the safety and optimally effective conditions for performing unilateral gammaknife (GK) thalamotomy for tremors of Parkinson’s disease (PD) and essential tremor (ET), a prospectivemulti-institutional study was conducted by JLGK society (JLGK0301).Methods: In total, 72 patients (tremor dominant PD, n = 59; ET, n = 13) were registered at six institutes.Following our selective thalamotomy procedure, the lateral part of the ventralis intermediusnucleus, 45% of the thalamic length from the anterior tip, was selected as the isocenter. A single 130Gy shot was applied using a 4-mm collimator. During the follow-up study, patients were examinedat intervals of 3, 6, 12, 18 and 24 months postoperatively. Evaluation included neurological examination,magnetic resonance imaging and/or computerized tomography, the unified Parkinson’s diseaserating scale (UPDRS), electromyography, medication change and video observations.Results: Final clinical effects were favorable. Of 53 patients who completed 24 months of follow-up,43 were evaluated as having excellent or good results (81.1%). Notably, UPDRS scores showedtremor improvement (Parts II and III). Based on tremor scores of UPDRS Part III for the treatedside, 58.1% of the PD patients and 60% of ET patients had score 0 (no tremor). Marked change inrigidity was statistically significant; however, gait and slow movement showed no significant changeduring follow-up. Thalamic lesion size fluctuated but converged to either an almost spherical shape(65.6%), a sphere with streaking (23.4%) or an extended high-signal zone (10.9%). No permanentclinical complications were observed.Conclusions: GK thalamotomy is an alternative treatment for intractable tremors. Less invasiveintervention may be beneficial to patients.28
16 th International Meeting of the Leksell Gamma Knife ® SocietyMarch 2012, Sydney, AustraliaFU-259Meta-analysis of gamma knife treatmentfor trigeminal neuralgia1,2José Lorenzoni, 2 Adrián Zárate, 1 Raúl De Ramón, 1,3 Leonardo Badinez,1Francisco Bova, 1 Claudio Lühr1Centro Gamma Knife Santiago, Gamma Knife Chile2Departamento de Neurocirugía, Pontificia Universidad Católica de Chile3Departamento de Radioterapia, Fundación Arturo López PérezObjective: To analyze the results published in the literature concerning Gamma Knife treatment fortrigeminal neuralgia focused on pain outcome, side effects and prognostic factors.Methods: A search in PubMed and Medline was performed looking for publications meeting thekeywords: trigeminal neuralgia, radiosurgery and Gamma Knife. Only clinical series were selected,excluding systematic reviews. When many publications from the same center were found, only the mostrecent was considered.The data studied were the latency for pain improvement, the initial pain response, the long-term paincontrol, treatment-related morbidity and prognostic factors for pain outcome. Pain control was assessedby the Barrow Neurological Institute Pain Scale (BNI) and long term pain control was evaluatedconsidering actuarial methods. Prognostic factors associated with pain outcome were classed as clinical,anatomo-radiological and dosimetric.Only significant prognostic factors in multivariate analysis were considered. For each variable threestudies were done. First, a study of the number of publications supporting the positive, neutral ornegative influence on pain outcome, then, a study considering the number of patients included in suchstudies and finally an integrated analysis of the hazard ratios.Results: Sixty one manuscripts published between 1997 and August 2011 were selected for thepurpose of this study. The mean latency period for pain control was 4.5 weeks (range 1.5 to 10), themean initial pain control for BNI I to BNI III (pain well controlled with or without medications) was86%. At five years the mean actuarial pain control was 54%. The average of sensory disturbanceswas communicated in 21.5%, (6.7% numbness or bothersome). Sensory dysfunction was morefrequent after repeated Gamma Knife treatment.The most consistent prognostic factors for better pain control were: absence of previous treatments,typical trigeminal neuralgia, absence of multiple sclerosis, irradiation dose ≥ 80 gray and post-treatmenthypoesthesia.Conclusions: Gamma knife treatment is a safe and useful modality for the treatment of trigeminalneuralgia with an initial adequate response in 86% and long-term pain control in one half of patients,comparable to other ablative treatments. Some prognostic factors for pain outcome were systematicallyidentified.29
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RRadatz Matthias 12, 16Radatz Matth
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