Management Of Intractable Pain In Gamma Knife Surgery: A Role Of Pituitary Radiosurgery With Subnecrotizing DoseHayashi Motohiro1, Noriko Tamura2, Mikhail Chernov3, Taku Ochiai4, Koutaro Nakaya1, Masahiro Izawa1, Shoji Yomo, MD5, Takaomi Taira MD1, Yoshikazu Okada1, Kintomo Takakura11Department of Neurosurgery 2Tokyo, Japan 31Department of Neurosurgery, Neurological Institute, Tokyo Women’s Medical University, Tokyo, Japan, 2Saitama Gamma Knife Center, San-ai Hospital, Saitama, Japan. 4 Saitama Gamma Knife Center 5Saitama Gamma Knife Center, San-ai Hospital Keywords: pain, cancer, gamma knife, pituitary adenoma, pituitary glandInteractive ManuscriptAsk Questions of this Manuscript: What is the background behind your study? What is the purpose of your study?To evaluate outcomes after pituitary radiosurgery in patients with bone related cancer pain (CP) and post-stroke thalamic pain syndrome (TP). Describe your patient group.From 2002 to 2009, 55 patients (CP: 15, TP: 40) underwent pituitary radiosurgery in our group institute and, 36 patients among of all were evaluated (12 in CP: at least 3 months, 24 in TP: at least 24 months follow up). Describe what you did.The radiosurgical target was defined as the pituitary gland, and the junction of pituitary stalk should be involved in the 50% isodose line. The maximum dose varied from 140 to 180 Gy. Mean follow-up after treatment was10 months in CP, and 46 months (range, 24–60 months) in TP. Describe your main findings.Initial pain reduction, usually within 48 hours after radiosurgery, was marked in 11 patients (91.7%) in CP, and 17 patients (71%) in TP. An efficacy of pain relief was sufficient and prolonged by the end of their life in CP. However, in the majority of cases in TP recurred within 6 months after treatment, and at the time of the last follow-up examination durable pain control was marked in only 6 patients (25%). Ten patients (27.8%) had treatment-associated side effects. Anterior pituitary abnormalities were marked in 8 cases and required hormonal replacement therapy in 3; transient diabetes insipidus was observed in 2 cases, transient hyponatremia in 2, and clinical deterioration due to increase of the numbness severity despite significant reduction of pain was seen once. Describe the main limitation of this study.This is a retrospective study. Describe your main conclusion.Pituitary radiosurgery for intractable pain results in a high rate of initial efficacy and is accompanied by acceptable morbidity. Describe the importance of your findings and how they can be used by others.It can be used as a primary minimally invasive management option for patients with bone related cancer pain and post-stroke thalamic pain resistant to medical therapy. However, in the majority of cases with thalamic pain syndrome recurrence occurs within 1 year after treatment. We should investigate inclusion criteria and retrospective analysis. To evaluate outcomes after pituitary radiosurgery in patients with bone related cancer pain (CP) and post-stroke thalamic pain syndrome (TP). From 2002 to 2009, 55 patients (CP: 15, TP: 40) underwent pituitary radiosurgery in our group institute and, 36 patients among of all were evaluated (12 in CP: at least 3 months, 24 in TP: at least 24 months follow up). The radiosurgical target was defined as the pituitary gland, and the junction of pituitary stalk should be involved in the 50% isodose line. The maximum dose varied from 140 to 180 Gy. Mean follow-up after treatment was10 months in CP, and 46 months (range, 24–60 months) in TP. Initial pain reduction, usually within 48 hours after radiosurgery, was marked in 11 patients (91.7%) in CP, and 17 patients (71%) in TP. An efficacy of pain relief was sufficient and prolonged by the end of their life in CP. However, in the majority of cases in TP recurred within 6 months after treatment, and at the time of the last follow-up examination durable pain control was marked in only 6 patients (25%). Ten patients (27.8%) had treatment-associated side effects. Anterior pituitary abnormalities were marked in 8 cases and required hormonal replacement therapy in 3; transient diabetes insipidus was observed in 2 cases, transient hyponatremia in 2, and clinical deterioration due to increase of the numbness severity despite significant reduction of pain was seen once. This is a retrospective study. Pituitary radiosurgery for intractable pain results in a high rate of initial efficacy and is accompanied by acceptable morbidity. It can be used as a primary minimally invasive management option for patients with bone related cancer pain and post-stroke thalamic pain resistant to medical therapy. However, in the majority of cases with thalamic pain syndrome recurrence occurs within 1 year after treatment. We should investigate inclusion criteria and retrospective analysis. Project Roles:
H. Motohiro (), N. Tamura (), M. Chernov (), T. Ochiai (), K. Nakaya (), M. Izawa (), S. Yomo (), T. MD (), Y. Okada (), K. Takakura ()
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