Fifteen years of Gamma Knife surgery for trigeminal neuralgia in the Journal of Neurosurgery: history of a revolution in functional neurosurgery.

摘要

In 1994 the Leksell Gamma Knife Society, under the presidency of Prof. Kintomo Takakura, held its meeting in Kyoto, Japan. I presented 5 cases of trigeminal neuralgia that had been successfully treated using the Gamma Knife at a dose of 90 Gy and an anterior cisternal target (retrogasserian target).27 My presentation was very well attended and raised a great deal of interest because of its "novelty"! In fact, 37 years earlier, the first radiosurgical procedure in a human had been performed by Lars Leksell to treat trigeminal neuralgia by targeting the gasseri-an ganglion as seen on x-ray films.12 After treating a series of 40 patients, the Leksell team abandoned this approach because Lars Leksell discovered the efficacy of the glyc-erol injection.8 This injection was first used for visualization of the Meckel cave but turned out to be sufficient to stop pain in a significant percentage of patients.8 The clear limitations of other medical and surgical therapeutic options, on the one hand, and the possibility of accurate direct targeting of the cisternal portion of the nerve, on the other hand, explains the revival of the idea of radio-surgery for tic douloureux in the early 1990s.