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Traitement de la névralgie trigéminale par Gamma-Knife

  • Jean RégisEmail author
  • Constantin Tuleasca

Résumé

Le concept même de radiochirurgie stéréotaxique a été inventé par Lars Leksell, en 1951 [1]. Sa première application clinique fut de traiter par un faisceau de rayons X tournant [2–4] des patients souffrant d’une névralgie faciale essentielle [5]. Le Gamma-Knife® (GK) avec deux cent une sources de cobalt a été finalement adopté par Leksell en 1968. Cependant, du fait d’une part de l’introduction de la technique de glycérol et de médicaments efficaces pour le traitement de la névralgie faciale, et d’autre part de l’absence d’une neuro-imagerie de haute qualité à l’époque permettant de visualiser directement et de viser le nerf trijumeau, le GK a été temporairement abandonné. Les progrès de l’imagerie par résonance magnétique de haute résolution à la fin des années 1990 — pour l’optimisation de la définition des structures normales — et l’évidence de certaines limitations des autres techniques ont incité une réévaluation de la radiochirurgie GK comme alternative [6, 7]. L’évidence de l’innocuité et de l’efficacité de la radiochirugie GK est basée sur des études rétrospectives et une seule étude prospective [8]. L’évidence soutenant l’utilisation d’autres modalités du traitement chirurgical de la névralgie faciale est seulement basée sur des études rétrospectives [5, 9]. Cependant, le débouclage microvasculaire (DMV) doit être considéré comme la technique de référence du fait de son action causale. L’hétérogénéité des résultats cliniques obtenus après un traitement radiochirurgical suggère un important impact des paramètres pré- et post-opératoires. Nous avons publié en 2006 [8] la seule étude prospective conforme aux critères strictes proposés par Zakrzewska [9] mais avec un recul minimal de « seulement » un an. Plus récemment, nous avons analysé les résultats à long terme de la globalité de notre série.

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Copyright information

© Springer-Verlag Paris 2014

Authors and Affiliations

  1. 1.Service de neurochirurgie fonctionnelle et stéréotaxiquehôpital de la Timone, CHU de MarseilleFrance
  2. 2.Service de neurochirurgie et centre Gamma-Knife®centre hospitalier universitaire vaudois, université de Lausanne, faculté de biologie et de médecineLausanneSuisse

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