Gamma Knife radiosurgery for the treatment of trigeminal neuralgia: A single center-experience

Akcakaya, Mehmet Osman; Mirkhasilova, Muyassar; Ozturk, Onur; Ugurlar, Doga; Tonge, Mehmet; Alco, Gul; Ercan, Tulay; Igdem, Sefik; Karadereler, Selhan

doi:10.1016/j.neucie.2024.04.001

array:22 ["pii" => "S2529849624000200" "issn" => "25298496" "doi" => "10.1016/j.neucie.2024.04.001" "estado" => "S300" "fechaPublicacion" => "2024-09-01" "aid" => "606" "copyright" => "Sociedad Española de Neurocirugía" "copyrightAnyo" => "2024" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Neurocirugia. 2024;35:225-32" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:19 [ "pii" => "S2529849624000285" "issn" => "25298496" "doi" => "10.1016/j.neucie.2024.05.003" "estado" => "S300" "fechaPublicacion" => "2024-09-01" "aid" => "609" "copyright" => "Sociedad Española de Neurocirugía" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Neurocirugia. 2024;35:233-40" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Clinical Research" "titulo" => "Short-term and long-term results of odontoid screw fixation in patients with Type II and rostral Type III dens fractures" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "233" "paginaFinal" => "240" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Resultados a corto y largo plazo de la fijación con tornillo del odontoide en pacientes con fracturas del dens tipo II y tipo III rostral" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1323 "Ancho" => 1508 "Tamanyo" => 63317 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Bone fusion in a patient with Type II fracture after odontoid screw fixation." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ivan Lvov, Andrey Grin, Aleksandr Talypov, Anton Kordonskiy, Aleksandr Tupikin" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Ivan" "apellidos" => "Lvov" ] 1 => array:2 [ "nombre" => "Andrey" "apellidos" => "Grin" ] 2 => array:2 [ "nombre" => "Aleksandr" "apellidos" => "Talypov" ] 3 => array:2 [ "nombre" => "Anton" "apellidos" => "Kordonskiy" ] 4 => array:2 [ "nombre" => "Aleksandr" "apellidos" => "Tupikin" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1130147324000289" "doi" => "10.1016/j.neucir.2024.04.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147324000289?idApp=UINPBA00004B" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529849624000285?idApp=UINPBA00004B" "url" => "/25298496/0000003500000005/v2_202409060916/S2529849624000285/v2_202409060916/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "Clinical Research" "titulo" => "Gamma Knife radiosurgery for the treatment of trigeminal neuralgia: A single center-experience" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "225" "paginaFinal" => "232" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Mehmet Osman Akcakaya, Muyassar Mirkhasilova, Onur Ozturk, Doga Ugurlar, Mehmet Tonge, Gul Alco, Tulay Ercan, Sefik Igdem, Selhan Karadereler" "autores" => array:9 [ 0 => array:3 [ "nombre" => "Mehmet Osman" "apellidos" => "Akcakaya" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Muyassar" "apellidos" => "Mirkhasilova" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "Onur" "apellidos" => "Ozturk" "email" => array:1 [ 0 => "onurozturk.ial@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 3 => array:3 [ "nombre" => "Doga" "apellidos" => "Ugurlar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Mehmet" "apellidos" => "Tonge" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "Gul" "apellidos" => "Alco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "f" "identificador" => "aff0030" ] ] ] 6 => array:3 [ "nombre" => "Tulay" "apellidos" => "Ercan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "f" "identificador" => "aff0030" ] ] ] 7 => array:3 [ "nombre" => "Sefik" "apellidos" => "Igdem" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "f" "identificador" => "aff0030" ] ] ] 8 => array:3 [ "nombre" => "Selhan" "apellidos" => "Karadereler" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "Department of Neurosurgery, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Neurosurgery, Rami Hospital, Istanbul, Turkey" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Neurosurgery, Acibadem Taksim Hospital, Istanbul, Turkey" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Department of Neurosurgery, Samatya Training and Research Hospital, Istanbul, Turkey" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Department of Neurosurgery, Medipol Mega Hospital, Istanbul, Turkey" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Department of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey" "etiqueta" => "f" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Radiocirugía Gamma-Knife para el tratamiento de la neuralgia del trigémino: una experiencia en un solo centro" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1818 "Ancho" => 1675 "Tamanyo" => 226554 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "T1 weigthed MRI shows distal target selection to anterior cisternal portion of TGN. Inner circle represent 50% isodose line whereas outer circle represents 20% isodose line. Note that 20% isodose line stays tangential to brainstem surface." ] ] ] "textoCompleto" => "IntroductionTrigeminal neuralgia (TGN) is considered as one of the most disturbing and painful conditions in humans. TGN is a common syndrome characterized by episodic severe pain, and the incidence is approximately 4.3–8 per 100000.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a> Several treatments are available for patients with TGN, including medical and surgical options. Although the first treatment of choice is antiepileptic drugs, >50% of the patients eventually require surgical intervention for pain relief.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> The most commonly employed surgical procedures include open surgery [microvascular decompression (MVD)], percutaneous procedures (percutaneous balloon compression, percutaneous glycerol rhizotomy, and radiofrequency thermocoagulation) and radiosurgery.Since the first report of radiosurgery for TGN by Lars Leksell with a prototype tool, Gamma Knife radiosurgery (GKRS) has emerged as a minimal invasive method.<a class="elsevierStyleCrossRefs" href="#bib0020">4–8</a> Many prospective and retrospective studies have demonstrated the safety and efficacy of GKRS in TGN.<a class="elsevierStyleCrossRefs" href="#bib0040">8,9</a>The aim of the present study is to assess the long-term results and outcome of a series of TGN patients that underwent GKRS in a single center.Material and methodsPatientsBetween May 2012 and December 2022, 53 patients underwent radiosurgery in our gamma knife center. Of these 53 patients, 45 were successfully followed up and included to the study. The eight patients excluded patients were lost to follow-up or they had a short follow-up (<6 months). The mean age of the study patients was 59.8 ± 11.9 years (range, 34–85). Of the 45 patients, 18 (40%) were man and 27 (60%) were women. The mean duration of the symptoms was 9.53 ± 7.2 years (range, 1–30 years). All patients had a history of extensive medical treatment with multiple drugs. Anticonvulsants such as carbamazepine, gabapentin and phenytoin were the most commonly used drugs. Four patients (8.9%) could not tolerate drugs' side effects. Twenty-four patients (53.3%) had a history of undergoing at least one surgery, with a mean of 1.92 surgical interventions.Two of these 24 patients had a history of undergoing GKRS at another center. Twenty-one patients (46.7%) had no history of undergoing any surgery. All patients had typical TGN. The right side was affected in 21 patients (46.7%), and the left side was affected in 24 patients (53.3%). In 14 patients (31.1%), a single trigeminal division was affected. V2 affection was in 7 patients and V3 affection in 7 patients. Sole V1 involvement was not detected (<a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a>). In 21 patients (46.7%) two different trigeminal divisions were affected (46.7%; V1–V2, n = 4 [8.9%]; V2–V3, n = 17 [37.8%]), and all three divisions were affected in 10 patients (22.2%).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Operative techniqueAll patients underwent GKRS. A Leksell model G stereotactic frame (Elekta Instruments AB, Stockholm, Sweden) was applied under local anesthesia. Thereafter, magnetic resonance imaging (MRI) was performed for planning the treatment with Leksell GammaPlan (Elekta Instruments AB, Stockholm, Sweden). A stereotactic MRI (non-gap continuous, square matrix) was performed to delineate trigeminal nerve, and T2-weighted, contrast-enhanced T1-weighted and constructive interference steady state (CISS) MRI sequences were obtained. All the GKRS procedures were performed using Leksell Gamma Knife Perfexion (Elekta Instruments AB, Stockholm, Sweden). Dose selection and planning were performed by a neurological surgeon, radiation oncologist and medical physicist. A single 4-mm isocenter was used in all instances, which is positioned to cover the anterior cisternal portion of the trigeminal nerve (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) or the root entry zone (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The anterior cisternal target was located 4–8.3 mm (mean 5.35 ± 1.5 mm) anterior to the emergence of the nerve, whereas the target for root entry zone target was located 1.6–3.9 mm (mean 2.95 ± 0.7 mm) anterior to the nerve emergence. The dosage used ranged between 80 and 90 Gy (mean 87.5 ± 2.8 Gy). For the anterior cisternal and root entry zone targets, the isocenter was positioned such that the brainstem surface stays tangential to 20% and 50% isodose lines, respectively. Furthermore, beam channel blocking was used to prevent the 15 Gy isodose line to cover <5% of brainstem.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>Pain reliefThe patients were classified according to their degree of pain experienced using the Barrow Neurological Institute (BNI) Scale as follows: Class I, no pain, no medication; Class II, occasional pain not requiring medication; Class IIIa, no pain, but continued medication; Class IIIb, pain controlled with medication; Class IV, pain not adequately controlled with medication; Class V, no pain relief (severe pain). BNI score of I-IIIb were indicative of successful treatment, and BNI scores of IV and V were considered as treatment failure.The patients were followed up with clinical visits at three months, six months and one year postoperatively. They were then followed up annually. Final treatment outcome was determined via direct conversations during control visits if possible, or via telephonic interviews conducted by physicians who were not involved in patient selection or management.Statistical analysisData distribution was assessed using skewness and kurtosis tests. After descriptive statistics were analyzed, the categorical variables were analyzed using Pearson chi-square and Fisher’s exact tests. The correlation between significant categorical variables studied using Pearson’s correlation test. The independent t-test was used to compare the variable among various subgroups. Interactions between the variables were examined using logistic regression test, and the odds ratio for each factor was calculated. All statistical analysis were conducted using SPSS (version 25.0., SPSS Inc.,IBM, Chicago, IL, USA). A p value of <0.05 was considered statistically significant.ResultsForty-five patients were followed-up by a mean time of 46.8 ± 38.5 months (12–127 months). The GKRS failed in nine patients (%20). They did not experience significant pain relief even after 12 months of follow-up, and they continued to have severe pain (BNI Class V). The initial success rate was 80% ( n = 36). Among these 36 patients in whom a degree of pain control was achieved, 27 patients (60%) belonged to BNI Class I (excellent pain control), 1 (2.2%) belonged to BNI Class II, 4 (8.9%) belonged to BNI Class IIIa and 4 (8.9%) belonged to BNI Class IIIb. In total, moderate pain control was achieved in eight patients (17.8%)(<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). Pain relief is achieved a mean 2.01 ± 2.1 months (range 1 day to 10 months) following GKRS. After GKRS, 30 patients (66.7%) experienced hypoesthesia in related dermatome. The target choise did not affect the development of hypoesthesia (p = 0.38). Furthermore, there were no significant difference in the distance from nerve emergence in the patients with and without hypoesthesia (3.95 ± 1.69 mm and 3.57 ± 1.17 mm respectively, p = 0.48).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>TGN reccured in 11 patients (24.4%). Mean duration to recurrence was 27.6 ± 14.9 months (range, 12–66). Among the patients with TGN recurrence, seven had BNI score of I, one had a score of II, two had a score of IIIa, and one had a score of IIIb. Two of the patients with recurrence (4.4%) deteriorated from BNI Class I to BNI Class II. So, these two patients still have a good pain control and they differ from the other patients who developed a recurrence. At the end of the follow-up period, 20 patients (44.4%) remained in the BNI Class I (excellent pain control). The mean follow-up of this subgroup was 72.35 ± 38.3 months (range, 15-127). Eight patients (17.8%) remained in the BNI Class IIIa or IIIb (moderate pain control). At the end of the mean 46.8 months follow-up, excellent to moderate pain control was achieved in 31 patients (68.9%).The followings were considered the factors affecting the treatment success rate and recurrence: age, the segment of TGN, history of previous surgery, existence of multiple sclerosis, TGN duration, radiation dose, and target distance from nerve emergence. Statistical analysis revealed that the treatments' success rate was not affected by target choice (p = 0.35). Furthermore, the target distance from the nerve emergence did not change the success rate. The mean distance in the success and failure group was 3.85 ± 1.63 and 3.59 ± 1.08 mm, respectively (p = 0.65). The target choice is not determinative for recurrence rate. The radiation dose was 87.6 ± 2.6 and 87 ± 3.4 Gy in the treatment success and failure groups, respectively (p = 0.56). Additionally, there was no statistically significance between the patients exposed to a dose of 90 Gy and those exposed a dose of <90 Gy (p = 0.77). At the end of the follow-up period, the rate of permanent pain control was 55.2% and 56.2% when targeting the anterior cisternal portion and root entry zone of the nerve, respectively (p = 0.56).Comparing to the other factors, the history of previous surgery demonstrated medium statistical significance as a predictor of both treatment failure (p = 0.002 and R = 0.47) and recurrence ( p = 0.002 and R = 0.54). (. A younger age was also a statistically significant predictor a recurrence (p = 0.01). In our study, surgical intervention for TGN was preferred for younger patients (56.3 ± 11.8 and 63.8 ± 10.9 years old, p = 0.03). Regression model analysis revealed that age was not a significant predictor of recurrence (p = 0.18) , whereas a history of previous surgery was a significant predictor ( (p = 0.02) (OR: 0.11 (95%CI: 0.017−0.739). Regression model analysis also revealed that the disease duration was not determinant of history of previous surgery( (8.64 ± 7.3 vs 12.9 ± 8 years, p = 0.16) or the recurrence (8.64 ± 7.3 vs 8.82 ± 5.9 years, p = 0.95 ).DiscussionSince the first case report of TGN treated with radiosurgery using a prototype guiding device linked to a dental X-ray machine by Lars Leksell in 1971,<a class="elsevierStyleCrossRef" href="#bib0025">5</a> and Lindquist’s publication on the progress of TGN patients following GKRS in 1991,<a class="elsevierStyleCrossRef" href="#bib0050">10</a> GKRS has become an established surgical treatment modality for medically refractory TGN. Due to its minimally invasive nature and very low complication rates, it is currently considered a treatment option initially as well as for disease recurrence.<a class="elsevierStyleCrossRefs" href="#bib0040">8,11–13</a> Although there are no randomized controlled trials that have compared the efficacy of GKRS and other surgical procedures, other studies indicate that they provide similar success rates.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> Young individuals with minimal comorbidities are eligible for MVD surgery as a first line of treatment, especially in patients with microvascular conflict.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> MVD provides a higher initial success rates (approximately 90%) as well as highest long-term pain control (61–88% after 10 years) than GKRS. However, MVD is a posterior fossa surgery, which may be associated with major complications such as cerebrospinal fluid leakage, hearing loss, hydrocephalus, extraocular muscle palsy, facial palsy, cerebellar edema, aseptic or bacterial meningitis, hemorrhage, brainstem infarction and, and rarely, even death.<a class="elsevierStyleCrossRefs" href="#bib0015">3,8,12,14</a>Percutaneous procedures provide an initial success rates of 73% to 100% and a recurrence free interval of 20–22 months.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> Percutaneous ablative procedures are associated with morbidities such as hypoesthesia, dysesthesia, corneal keratitis, masseter muscle weakness and anesthesia dolorosa.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> However, GKRS is generally associated with only mild complications, including trigeminal nerve sensory disturbance, which is related with dose and target location.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> The brainstem irradiation dose and the length of the irradiated nerve segment are the other predisposing factors.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> Most patients do not find this complication disabling or bothersome, and consider as a good tradeoff for pain relief.<a class="elsevierStyleCrossRefs" href="#bib0040">8,9</a> Post-GKRS hypoesthesia in the trigeminal nerve distribution is predictive of pain relief,<a class="elsevierStyleCrossRef" href="#bib0080">15</a> making it a “desired” postoperative complication. Regis et al. reported only 11 cases (2.2%) of bothersome facial numbness in their study of 497 patients.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> Prk et al. reported dysesthesia (1.4%) and dry eye syndrome (2.8%) following GKRS.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> No other complications have been reported following GKRS for TGN. According to Urgosik et al., TGN sensory disturbance is the only significant post-GKRS side effect in clinical practice.<a class="elsevierStyleCrossRef" href="#bib0085">16</a> Similar to the findigns of previous publications, postoperative numbness or hypoesthesia was the only post-GKRS complication in our study (n = 30; 66.7%). No other complications were encountered.Various studies have reported an initial success rate, in terms of pain relief, of 70% to 98%.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> Kondziolka et al., Regis et al., Marshall et al., and Lucas et al.reported 89% pain relief in 503 patients,<a class="elsevierStyleCrossRef" href="#bib0055">11</a> 91.75% in 497 patients,<a class="elsevierStyleCrossRef" href="#bib0040">8</a> 86% in 448 patients<a class="elsevierStyleCrossRef" href="#bib0090">17</a>, and 84.5% in 446 patients<a class="elsevierStyleCrossRef" href="#bib0095">18</a>, respectively. Although having a slight lower initial success rate compared to these four largest series in the published literature, our study demostrates an 80% pain relief in 45 patients. Exellent pain control was achieved in 60% of the patients (BNI score I), and moderate pain control was achieved in 20% (BNI scores II, IIIa and IIIb). Among these patients, 20 patients (44.4%) remained pain- and drug-free for a mean of 72.4 months. Fourteen of these 20 patients (70%) had not previously undergone surgery. Thus, GKRS might provide a much longer pain-free follow-up as the first line of treatment. As our statistical analysis revealed, the history of previous surgery was a significant factor influencing both recurrence and initial failure rates.Other surgical treatments prior to GKRS are associated with lesser pain relief.<a class="elsevierStyleCrossRef" href="#bib0100">19</a> Additionally, failure of one surgical treatment reduced the expectation of complete pain relief.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> We found a significant correlation between the initial success rate and the absence of a previous surgical intervention. In the study by Regis et al., 65.2% of 497 patients had no history of previous surgery. They found that GKRS was a rational first line of treatment for TGN, considering itsminimally invasive nature.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> In different publications, two or more surgeries was associated with treatment failure or higher recurrence rates.<a class="elsevierStyleCrossRefs" href="#bib0040">8,11</a> Therefore, we believe that GKRS is a safe and efficient primary treatment for TGN, which produces pain control for a sufficient duration. However, prospective controlled randomized studies with greater sample size must be conducted to validate our findings.Although the pathophysiology of TGN is not fully understood, both central and peripheral mechanisms were considered in pathogenesis. Neurovascular compression due to aberrant blood vessel loops in the cisternal segment of trigeminal nerve is most frequently responsible for TGN.<a class="elsevierStyleCrossRefs" href="#bib0060">12,13,20</a> Chronic neurovascular compression causes demyelination of the sensory fibers within the proximal nerve root, which leads to hyperexcitability and clinical symptoms. GKRSmost probably causes ionic channel blockage/destruction in addition to focal axonal degeneration, which reduces paroxysms and pain.<a class="elsevierStyleCrossRefs" href="#bib0060">12,21,22</a> Additionally, irradiation is presumed to be responsible for delayed axonal degeneration, which may account for the significant amount of patients experiencing late pain relief.<a class="elsevierStyleCrossRef" href="#bib0120">23</a> Regis et al. reported a median latency of 10 days (range, 1–180 days),<a class="elsevierStyleCrossRef" href="#bib0040">8</a> whereas Kondziolka et al. reported a median latency of 1 month (range, 1 day–1 year).<a class="elsevierStyleCrossRef" href="#bib0055">11</a> Although current studies report a latency of 15–78 days after GKRS until pain relief,<a class="elsevierStyleCrossRef" href="#bib0125">24</a> a latency of up to 6 months even 1 year has been reported.<a class="elsevierStyleCrossRefs" href="#bib0055">11,12</a> In our study, the mean latency period was 2 months (range, 1 day–10 months), which is similar to the findings in literature.Another significant parameter, which might affect the outcomes, is the target selection. The trigeminal root entry zone is the transition zone between the peripheral and central myelinization.<a class="elsevierStyleCrossRef" href="#bib0130">25</a> Oligodendrocytes are more radiosensitivethan Schwann cells, which are responsible of peripheral myelinization.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> Therefore, targeting the root entry zone may result in superior pain relief, which is associated with the greater brainstem volumes receiving higher irridation doses.<a class="elsevierStyleCrossRefs" href="#bib0030">6,20,21</a> However, some studies propose that targeting the anterior cisternal portionreduces the doses to the brainstem and the associated complications.<a class="elsevierStyleCrossRef" href="#bib0135">26</a> Targeting the distal portion of the nerve is as effective as targeting the proximal portion in producing pain relief. Furthermore, the complication rates are lower when targeting the distal target.<a class="elsevierStyleCrossRefs" href="#bib0040">8,20</a> In our study, the neurosurgeons (MOA, DU, SK) chose the target according to their own understanding of the disease and treatment strategy. Our retrospective study spanned 10 years, and included both anterior cisternal portion and the root entry zone as targets. We did not find any significant association between target selection and outcomes in this wide period. Although proximal target selection reportedly significantly affects the development of post-GKRS hypoesthesia,<a class="elsevierStyleCrossRefs" href="#bib0140">27,28</a> we did not find a difference in hypoesthesia development between proximal and distal targeting. This may be attributed to the fact that patients were partially interviewed telephonically regarding their latest clinical condition, as mentioned by Urgosik et al.<a class="elsevierStyleCrossRef" href="#bib0085">16</a> The limited number of patients may have also played a role in this result.Previous studies have demostrated that the doses of <70 Gy do not relieve TGN-related pain, and they produce a limited structural effect on the trigeminal nerve.<a class="elsevierStyleCrossRefs" href="#bib0150">29,30</a> Doses of >80 Gy might cause partial degeneration with axonal degeneration and demyelination, which is associated with pain relief.<a class="elsevierStyleCrossRef" href="#bib0155">30</a> Although doses of >90 Gy produces similar pain relief, it is associated with higher complication rates.<a class="elsevierStyleCrossRefs" href="#bib0055">11,12</a> Therefore, a dose between 80 and 90 Gy is generally used. We administered 80 Gy to only two patients, who experienced moderate pain relief and initial failure, respectively. However, this finding cannot be solely attributed to the treatment dose because of the limited number of patients and numerous associated factors. In the remaining 43 patients,a dose of 85to 90 Gy were used. We did not find any correlation between the treatment dose and outcome. Similarly, we did not find any statistically significant relation with the treatment dose and complications.Recurrence rates in the published literature vary greatly. In one study, recurrence rate was 3.3% within a relatively short-term follow-up of 19.8 months.<a class="elsevierStyleCrossRef" href="#bib0160">31</a> Recently, Zhao et al. reported a recurrence rate of 3.6% in 49.7 months.<a class="elsevierStyleCrossRef" href="#bib0165">32</a> However, higher recurrence rates were reported in some series with shorter follow-up. Kondziolka et al. reported a recurrence rate of 42.9% among 503 patients in 24 months.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> Lucas et al. reported a recurrence rate of 45.6% among 446 patients in 21.2 months.<a class="elsevierStyleCrossRef" href="#bib0095">18</a> In our study, the recurrence rate was 27.5% within 46.8 months, which was similar to the findings of previous studies in which the recurrence rate was 25–31.2% within 30–64.7 months.<a class="elsevierStyleCrossRefs" href="#bib0085">16,33,34</a> The statistically significant factors affecting recurrence rates were younger age and a history of previous surgeries. However, regression model analysis revealed that a history of the previous surgeries was the only statistically significant factor; the statistical significance of age was diminshed. Additionally, we found a correlation between younger age and increased number of previous surgeries. There is a tendency of more aggressive selection of surgical options in the management of younger patients,<a class="elsevierStyleCrossRef" href="#bib0040">8</a> whereas elderly patients were commonly managed with conservative medical treatment. As a result of it, there was overlapping in history of previous surgeries and younger age in our study. We believe this explains why we identified younger age as a significant factor in recurrence rates during the single-factor analysis, but the regression model excluded younger age as a recurrence factor by detecting this co-occurrence.This study had several limitations. First, despite the considerably long follow-up period, the sample size is relatively small, the treatment was performed on different targets with different doses. Second, this is a retrospective study. Although we had not initally aimed to compare the different treatment groups, we attempted to draw some calculations using the data collected. Third, most patients were interviewed telephonically to determine their latest condition. There may be some subjectivity involved, as certain complaints that seem unimportant to the patientmay be significant for the physician, such as the presence of hypoesthesia. If the patient did not mention it or attribute importance to it, it cannot be reported.ConclusionGKRS is a safe and efficient method to manage medically refractory trigeminal neuralgia both as a primary or non-primary treatment option. Despite all the precautions, sensory impairment may occur following the procedure. However, GKRS is associated with better pain control in long term.FundingNo funding.Conflict of interestMehmet Osman Akcakaya, Muyassar Mirkhasilova, Onur Ozturk, Doga Ugurlar, Mehmet Tonge, Gul Alco, Tulay Ercan, Sefik Igdem and Selhan Karadereler declare that they have no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres2236868" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1872191" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xpalclavsec1872190" "titulo" => "Abbreviations" ] 3 => array:3 [ "identificador" => "xres2236869" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Materiales y Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 4 => array:2 [ "identificador" => "xpalclavsec1872192" "titulo" => "Palabras clave" ] 5 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 6 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patients" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Operative technique" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Pain relief" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] ] ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Conclusion" ] 10 => array:2 [ "identificador" => "sec0050" "titulo" => "Funding" ] 11 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflict of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-11-16" "fechaAceptado" => "2024-03-20" "PalabrasClave" => array:2 [ "en" => array:2 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1872191" "palabras" => array:4 [ 0 => "Trigeminal neuralgia" 1 => "Gamma Knife" 2 => "Radiosurgery" 3 => "Outcome" ] ] 1 => array:4 [ "clase" => "abr" "titulo" => "Abbreviations" "identificador" => "xpalclavsec1872190" "palabras" => array:10 [ 0 => "BNI Scale" 1 => "CISS" 2 => "GKRS" 3 => "MRI" 4 => "MS" 5 => "MVD" 6 => "PBC" 7 => "PGR" 8 => "RF" 9 => "TGN" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1872192" "palabras" => array:4 [ 0 => "Neuralgia del trigémino" 1 => "Gamma-Knife" 2 => "Radiocirugía" 3 => "Resultado" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Introduction and objectivesWe aimed to assess the outcomes of patients with trigeminal neuralgia (TGN) who underwent Gamma Knife radiosurgery (GKRS). Materials and methodsFifty-three patients with typical TGN underwent GKRS from May 2012 until December 2022. Among these patients, 45 patients who were follow-up for at least 12 months were included in the study. A mean dose of 87.5 Gy (range, 80–90) was administered to the trigeminal nerve. Postoperatively, outcome was considered excellent if the patient was pain- and medication-free. ResultsThe mean symtpom duration was 9.53 years, and the mean patient age was 59.8 years (range, 34–85). The mean follow-up period was 46.8 months (range, 12–127 months). 46.7% of patients had a history of previous surgical interventions. A single nerve division was affected in 14 patients (31.1%), and multiple divisions were affected in 31 patients (68.9%). The rate of initial pain relief was 80%. Hypoesthesia in the area of trigeminal nerve developed in 30 (66.7%). Twenty patients (44.4%) exhibited excellent results within 72.4 months. Recurrence occurred in 11 patients (24.4%) with 27.6 months. ConclusionsOur results suggest that GKRS is a safe and effective procedure. Thus, it is an attractive first- and second-line treatment choice for TGN." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "Introducción y objetivosNuestro objetivo fue evaluar los resultados de los pacientes con neuralgia del trigémino (TGN) que se sometieron a radiocirugía con Gamma Knife (GKRS) Materiales y MétodosCincuenta y tres pacientes con TGN tipica se sometieron a GKRS entre mayo de 2012 y diciembre de 2022. Entre estos pacientes, se incluyeron al estudio 45 pacientes que fueron seguidos durante al menos 12 meses. Se administró una dosis media de 87,5 Gy (rango, 80-90) al nervio trigémino. El resultado postoperatorio se consideró excelente si el paciente no padecía dolor ni medicación. ResultadosLa duración media de los síntomas fue de 9,53 años y la edad media de los pacientes fue de 59,8 (rango, 34 a 85). El período medio de seguimiento fue de 46,8 meses (rango, 12-127 meses). El 46,7% de los pacientes tenía antecedentes de intervenciones quirúrgicas previas. Una sola división nerviosa se vio afectada en 14 pacientes (31,1%) y multiples divisiones en 31 pacientes (68,9%). La tasa de alivio del dolor inicial fue del 80%. La hipoestesia en el área de distribución del nervio trigémino se desarolló en 30 pacientes (66,7%).Viente pacientes (44,4%) mostraron excelentes resultados en 72,4 meses. La recurrencia se desarolló en 11 pacientes (24,4%) con 27,6 meses. ConclusionesNuestros resultados sugieren que GKRS es un procedimiento seguro y eficaz. Por tantı, es una opción atractiva de primera y segunda línea para la TGN." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Materiales y Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1082 "Ancho" => 1675 "Tamanyo" => 171511 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "CISS MRI shows proximal target selection to REZ of TGN. Inner circle (yellow) represents 50% isodose line and outer circle (green) represents 20% isodose line. Note that 50% isodose line stays tangential to brainstem surface." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1818 "Ancho" => 1675 "Tamanyo" => 226554 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "T1 weigthed MRI shows distal target selection to anterior cisternal portion of TGN. Inner circle represent 50% isodose line whereas outer circle represents 20% isodose line. Note that 20% isodose line stays tangential to brainstem surface." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:2 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Treatment \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Success</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Failure</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (year) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Duration of symptoms (year) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3645907.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Side</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Left \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Segment</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">V1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">V2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">V3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">V1-V2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">V2-V3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">V1-V2-V3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3645909.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Demographics." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="4" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Present</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Absent</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total n \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n/P \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Previous Surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.92 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Radiofrequency \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Balloon compression \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Glycerol injection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">93.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Microvascular decompression \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gamma Knife \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3645906.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Previous surgery." ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">BNI \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">I</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">II</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IIIa</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IIIb</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IV</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">V</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Early control \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Final control \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3645908.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Early and final BNI scale." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:34 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence and clinical features of trigeminal neuralgia, Rochester, Minnesota, 1945-1984" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Katusic" 1 => "C.M. Beard" 2 => "E. Bergstralh" 3 => "L.T. Kurland" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ana.410270114" "Revista" => array:6 [ "tituloSerie" => "Ann Neurol" "fecha" => "1990" "volumen" => "27" "paginaInicial" => "89" "paginaFinal" => "95" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2301931" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The incidence and lifetime prevalance of neurological disorders in a community-based study in the UK" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "B.K. MacDonald" 1 => "O.C. Cockerell" 2 => "J.W. Sander" 3 => "S.D. Shorvon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/brain/123.4.665" "Revista" => array:7 [ "tituloSerie" => "Brain" "fecha" => "2000" "volumen" => "123" "numero" => "Pt 4" "paginaInicial" => "665" "paginaFinal" => "676" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10733998" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The long term outcome of microvascular decompression for trigeminal neuralgia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F.G. Barker 2nd" 1 => "P.J. Jannetta" 2 => "D.J. Bissonette" 3 => "M.V. Lerkins" 4 => "H.D. Jho" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "N Eng J Med" "fecha" => "1996" "volumen" => "334" "paginaInicial" => "1077" "paginaFinal" => "1083" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cerebral radiosurgery. I. Gammathalanotomy in two cases of intractable pain" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L. Leksell" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Chir Scand" "fecha" => "1968" "volumen" => "134" "paginaInicial" => "585" "paginaFinal" => "595" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5713443" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sterotaxic radiosurgery in trigeminal neuralgia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L. Leksell" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Chir Scand" "fecha" => "1971" "volumen" => "137" "paginaInicial" => "311" "paginaFinal" => "314" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4948331" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Stereotactic radiosurgery for trigeminal neuralgia: a multiinstitutional study using the gamma unit" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Kondziolka" 1 => "L.D. Lunsford" 2 => "J.C. Flickinger" 3 => "R.F. Young" 4 => "S. Vermeulen" 5 => "C.M. Duma" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3171/jns.1996.84.6.0940" "Revista" => array:7 [ "tituloSerie" => "J Neurosurg" "fecha" => "1996" "volumen" => "84" "numero" => "6" "paginaInicial" => "940" "paginaFinal" => "945" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8847587" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Leksell Gamma Knife treatment of tic douloureux" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R.W. Rand" 1 => "D.B. Jacques" 2 => "R.W. Melbye" 3 => "B.G. Coppcutt" 4 => "M.N. Levenick" 5 => "M.R. Fisher" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000100663" "Revista" => array:7 [ "tituloSerie" => "Stereotact Funct Neurosurg" "fecha" => "1993" "volumen" => "61" "numero" => "Suppl 1" "paginaInicial" => "93" "paginaFinal" => "102" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8115760" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Longterm safety and efficacy of Gamma Knife surgery in classical trigeminal neuralgia: a 497-patient historical cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Regis" 1 => "C. Tuleasca" 2 => "N. Resseguier" 3 => "R. Carron" 4 => "A. Donnet" 5 => "J. Gaudart" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3171/2015.2.JNS142144" "Revista" => array:7 [ "tituloSerie" => "J Neurosurg" "fecha" => "2016" "volumen" => "124" "numero" => "4" "paginaInicial" => "1079" "paginaFinal" => "1087" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26339857" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gamma Knife surgery in trigeminal neuralgia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Wolf" 1 => "D. Kondziolka" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.nec.2016.02.006" "Revista" => array:6 [ "tituloSerie" => "Neurosurg Clin N Am" "fecha" => "2016" "volumen" => "27" "paginaInicial" => "297" "paginaFinal" => "304" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27324996" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Functional neurosurgery-a future for the gamma knife?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Lindquist" 1 => "L. Kihlström" 2 => "E. Hellstrand" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000099557" "Revista" => array:6 [ "tituloSerie" => "Stereotact Funct Neurosurg" "fecha" => "1991" "volumen" => "57" "paginaInicial" => "72" "paginaFinal" => "81" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1725560" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gamma Knife stereotactic radiosurgery for idiopathic trigeminal neuralgia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Kondziolka" 1 => "O. Zorro" 2 => "J. Lobato-Polo" 3 => "H. Kano" 4 => "T.J. Flannery" 5 => "J.C. Flickinger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3171/2009.7.JNS09694" "Revista" => array:6 [ "tituloSerie" => "J Neurosurg" "fecha" => "2010" "volumen" => "112" "paginaInicial" => "758" "paginaFinal" => "765" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19747055" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gamma Knife radiosurgery on the trigeminal root entry zon efor idiopathic trigeminal neuralgia: Results and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.H. Park" 1 => "J.W. Chang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3349/ymj.2020.61.2.111" "Revista" => array:7 [ "tituloSerie" => "Yonsei Med J" "fecha" => "2020" "volumen" => "61" "numero" => "2" "paginaInicial" => "111" "paginaFinal" => "119" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31997619" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bibliometric analysis of the top 100 cited articles on stereotactic radiosurgery for trigeminal neuralgia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Parikh" 1 => "H.M. Abdallah" 2 => "A. Patel" 3 => "R.K. Shariff" 4 => "K.W. Nowicki" 5 => "A.N. Mallela" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-0043-1761240" "Revista" => array:7 [ "tituloSerie" => "Asian J Neurosurg" "fecha" => "2023" "volumen" => "18" "numero" => "1" "paginaInicial" => "101" "paginaFinal" => "107" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/37056872" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0075" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The efficacy and safety of microvascular decompression for idiopathic trigeminal neuralgia in patients older than 65 years" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.B. Yang" 1 => "Z.M. Wang" 2 => "D.Y. Jiang" 3 => "H.C. Chen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/SCS.0000000000000869" "Revista" => array:6 [ "tituloSerie" => "J Craniofac Surg" "fecha" => "2014" "volumen" => "25" "paginaInicial" => "1393" "paginaFinal" => "1396" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24816027" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0080" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of various surgical modalities in recurrent or persistent trigeminal neuralgia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Han" 1 => "D. Shin" 2 => "J. Chang" 3 => "K. Kim" 4 => "J. Chang" 5 => "R. Huh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000303530" "Revista" => array:7 [ "tituloSerie" => "Stereotact Funct Neurosurg" "fecha" => "2010" "volumen" => "88" "numero" => "3" "paginaInicial" => "156" "paginaFinal" => "162" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20357523" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0085" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of essential trigeminal neuralgia with gamma knife surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D. Urgosik" 1 => "R. Liscak" 2 => "J. Novotny" 3 => "J. Vymazal" 4 => "V. Vladyka" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Neurosurg (Suppl)" "fecha" => "2005" "volumen" => "102" "paginaInicial" => "29" "paginaFinal" => "33" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0090" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictive variables for the successful treatment of trigeminal neuralgia with gamma knife radiosurgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Marshall" 1 => "M.D. Chan" 2 => "T.P. McCoy" 3 => "A.C. Aubuchon" 4 => "J.D. Bourland" 5 => "K.P. McMullen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1227/NEU.0b013e3182320d36" "Revista" => array:6 [ "tituloSerie" => "Neurosurgery" "fecha" => "2012" "volumen" => "70" "paginaInicial" => "566" "paginaFinal" => "573" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21849918" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0095" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictive nomogram for the durability of pain relief from gamma knife radiation surgery in the treatment of trigeminal neuralgia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.T. Lucas Jr" 1 => "A.M. Nida" 2 => "S. Isom" 3 => "K. Marshall" 4 => "J.D. Bourland" 5 => "A.W. Laxton" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijrobp.2014.01.023" "Revista" => array:7 [ "tituloSerie" => "Int J Radiat Oncol Biol Phys" "fecha" => "2014" "volumen" => "89" "paginaInicial" => "120" "paginaFinal" => "126" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24613811" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1529943013013910" "estado" => "S300" "issn" => "15299430" ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0100" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gamma knife radiosurgery for trigeminal neuralgia: dose-volume histograms of the brainstem and trigeminal nerve" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Brisman" 1 => "R. Mooij" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3171/jns.2000.93.supplement" "Revista" => array:7 [ "tituloSerie" => "J Neurosurg" "fecha" => "2000" "volumen" => "93" "numero" => "1 Suppl 3" "paginaInicial" => "155" "paginaFinal" => "158" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11143235" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0105" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gamma knife radiosurgery for trigeminal neuralgia: first case series from Latin America" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Constanzo" 1 => "R.S.D. Silva" 2 => "D.B. de Almeida" 3 => "M.A. Ferragut" 4 => "M. Coelho Neto" 5 => "H.V. Toledo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/0004-282X20190027" "Revista" => array:7 [ "tituloSerie" => "Arq Neuropsiquiatr" "fecha" => "2019" "volumen" => "77" "numero" => "4" "paginaInicial" => "232" "paginaFinal" => "238" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31090803" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0110" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Histological effects of trigeminal nerve radiosurgery in a primate model: implications for trigeminal neuralgia radiosurgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Kondziolka" 1 => "D. Lacomis" 2 => "A. Niranjan" 3 => "Y. Mori" 4 => "S. Maesawa" 5 => "W. Fellows" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00006123-200004000-00038" "Revista" => array:7 [ "tituloSerie" => "Neurosurgery" "fecha" => "2000" "volumen" => "46" "numero" => "4" "paginaInicial" => "971" "paginaFinal" => "976" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10764273" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0115" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Radiation mechanisms of pain control in classical trigeminal neuralgia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Gorgulho" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/2152-7806.92931" "Revista" => array:7 [ "tituloSerie" => "Surg Neurol Int" "fecha" => "2012" "volumen" => "3" "numero" => "2 Suppl 1" "paginaInicial" => "17" "paginaFinal" => "25" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22439108" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0120" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical outcomes after stereotactic radiosurgery for idiopathic trigeminal neuralgia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Maesawa" 1 => "C. Salame" 2 => "J.C. Flickinger" 3 => "S. Pirris" 4 => "D. Kondziolka" 5 => "L.D. Lunsford" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3171/jns.2001.94.1.0014" "Revista" => array:6 [ "tituloSerie" => "J Neurosurg" "fecha" => "2001" "volumen" => "94" "paginaInicial" => "14" "paginaFinal" => "20" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11147887" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0125" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Stereotactic radiosurgery for trigeminal neuralgia: a systematic review: International Stereotactic Radiosurgery Society Practice Guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Tuleasca" 1 => "J. Régis" 2 => "A. Sahgal" 3 => "A. De Salles" 4 => "M. Hayashi" 5 => "L. Ma" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3171/2017.9.JNS17545" "Revista" => array:6 [ "tituloSerie" => "J Neurosurg" "fecha" => "2018" "volumen" => "130" "paginaInicial" => "733" "paginaFinal" => "757" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29701555" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0130" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Varying length of central myelin along the trigeminal nerve might contribute to trigeminal neuralgia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. Nomura" 1 => "H. Ryu" 2 => "K. Ohno" 3 => "K. Sato" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ca.23348" "Revista" => array:7 [ "tituloSerie" => "Clin Anat" "fecha" => "2019" "volumen" => "32" "numero" => "04" "paginaInicial" => "541" "paginaFinal" => "545" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30719770" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0135" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gamma knife surgery for idiopathic trigeminal neuralgia performed using a far-anterior cisternal target and a high dose of radiation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N. Massager" 1 => "J. Lorenzoni" 2 => "D. Devriendt" 3 => "F. Desmedt" 4 => "J. Brotchi" 5 => "M. Levivier" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3171/jns.2004.100.4.0597" "Revista" => array:7 [ "tituloSerie" => "J Neurosurg" "fecha" => "2004" "volumen" => "100" "numero" => "4" "paginaInicial" => "597" "paginaFinal" => "605" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15070111" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0140" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High-dose trigeminal neuralgia radiosurgery associated with increased risk of trigeminal nerve dysfunction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B.E. Pollock" 1 => "L.K. Phuong" 2 => "R.L. Foote" 3 => "S.L. Stafford" 4 => "D.A. Gorman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00006123-200107000-00008" "Revista" => array:6 [ "tituloSerie" => "Neurosurgery" "fecha" => "2001" "volumen" => "49" "paginaInicial" => "58" "paginaFinal" => "64" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11440460" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0145" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prospective controlled trial of gamma knife surgery for essential trigeminal neuralgia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Regis" 1 => "P. Metellus" 2 => "M. Hayashi" 3 => "P. Roussel" 4 => "A. Donnet" 5 => "F. Bille-Turc" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3171/jns.2006.104.6.913" "Revista" => array:7 [ "tituloSerie" => "J Neurosurg" "fecha" => "2006" "volumen" => "104" "numero" => "6" "paginaInicial" => "913" "paginaFinal" => "924" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16776335" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0150" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gamma knife radiosurgery for trigeminal neuralgia: a study of predictors of success, efficacy, safety, and outcome at LSUHSC" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Shaya" 1 => "A. Jawahar" 2 => "G. Caldito" 3 => "A. Sin" 4 => "B.K. Willis" 5 => "A. Nanda" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.surneu.2003.11.027" "Revista" => array:6 [ "tituloSerie" => "Surg Neurol" "fecha" => "2004" "volumen" => "61" "paginaInicial" => "529" "paginaFinal" => "534" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15165787" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0155" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gamma Knife irradiation-induced histopathological changes in the trigeminal nerves of rhesus monkeys" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Z.F. Zhao" 1 => "L.Z. Yang" 2 => "C.L. Jiang" 3 => "Y.R. Zheng" 4 => "J.W. Zhang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Neurosurg" "fecha" => "2010" "volumen" => "113" "paginaInicial" => "39" "paginaFinal" => "44" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21218532" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0160" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gamma knife radiosurgery for the treatment of trigeminal neuralgia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.F. Young" 1 => "S. Vermulen" 2 => "A. Posewitz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000056422" "Revista" => array:7 [ "tituloSerie" => "Stereotact Funct Neurosurg" "fecha" => "1998" "volumen" => "70" "numero" => "Suppl 1" "paginaInicial" => "192" "paginaFinal" => "199" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9782251" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0165" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcomes of two-isocenter gamma knife radiosurgery for patients with typical trigeminal neuralgia: pain response and quality of life" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "H. Zhao" 1 => "Y. Shen" 2 => "D. Yao" 3 => "N. Xiong" 4 => "A. Abdelmaksoud" 5 => "H. Wang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.wneu.2017.10.014" "Revista" => array:6 [ "tituloSerie" => "World Neurosurg" "fecha" => "2018" "volumen" => "109" "paginaInicial" => "e531" "paginaFinal" => "538" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29038085" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0170" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effectiveness of Gamma Knife Radiosurgery in improving psychophysical performance and patient’s quality of life in idiopathic trigeminal neuralgia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Gagliardi" 1 => "A. Spina" 2 => "M. Bailo" 3 => "N. Boari" 4 => "A. Cavalli" 5 => "A. Franzin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.wneu.2017.11.096" "Revista" => array:6 [ "tituloSerie" => "World Neurosurg" "fecha" => "2018" "volumen" => "110" "paginaInicial" => "e776" "paginaFinal" => "785" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29174233" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0175" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Radiosurgical treatment of trigeminal neuralgia: evaluating quality of life and treatment outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.H. Petit" 1 => "J.M. Herman" 2 => "S. Nagda" 3 => "S.J. DiBiase" 4 => "L.S. Chin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Radiat Oncol Biol Phys" "fecha" => "2003" "volumen" => "56" "paginaInicial" => "1147" "paginaFinal" => "1153" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/25298496/0000003500000005/v2_202409060916/S2529849624000200/v2_202409060916/en/main.assets" "Apartado" => array:4 [ "identificador" => "65581" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Clinical research" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/25298496/0000003500000005/v2_202409060916/S2529849624000200/v2_202409060916/en/main.pdf?idApp=UINPBA00004B&text.app=https://revistaneurocirugia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529849624000200?idApp=UINPBA00004B"]

 array:22 [
  "pii" => "S2529849624000200"
  "issn" => "25298496"
  "doi" => "10.1016/j.neucie.2024.04.001"
  "estado" => "S300"
  "fechaPublicacion" => "2024-09-01"
  "aid" => "606"
  "copyright" => "Sociedad Espa&#241;ola de Neurocirug&#237;a"
  "copyrightAnyo" => "2024"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Neurocirugia. 2024;35:225-32"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2529849624000285"
    "issn" => "25298496"
    "doi" => "10.1016/j.neucie.2024.05.003"
    "estado" => "S300"
    "fechaPublicacion" => "2024-09-01"
    "aid" => "609"
    "copyright" => "Sociedad Espa&#241;ola de Neurocirug&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Neurocirugia. 2024;35:233-40"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Clinical Research</span>"
      "titulo" => "Short-term and long-term results of odontoid screw fixation in patients with Type II and rostral Type III dens fractures"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "233"
          "paginaFinal" => "240"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Resultados a corto y largo plazo de la fijaci&#243;n con tornillo del odontoide en pacientes con fracturas del dens tipo II y tipo III rostral"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0015"
          "etiqueta" => "Fig&#46; 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 1323
              "Ancho" => 1508
              "Tamanyo" => 63317
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0015"
              "detalle" => "Fig&#46; "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Bone fusion in a patient with Type II fracture after odontoid screw fixation&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Ivan Lvov, Andrey Grin, Aleksandr Talypov, Anton Kordonskiy, Aleksandr Tupikin"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Ivan"
              "apellidos" => "Lvov"
            ]
            1 => array:2 [
              "nombre" => "Andrey"
              "apellidos" => "Grin"
            ]
            2 => array:2 [
              "nombre" => "Aleksandr"
              "apellidos" => "Talypov"
            ]
            3 => array:2 [
              "nombre" => "Anton"
              "apellidos" => "Kordonskiy"
            ]
            4 => array:2 [
              "nombre" => "Aleksandr"
              "apellidos" => "Tupikin"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S1130147324000289"
        "doi" => "10.1016/j.neucir.2024.04.002"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147324000289?idApp=UINPBA00004B"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529849624000285?idApp=UINPBA00004B"
    "url" => "/25298496/0000003500000005/v2_202409060916/S2529849624000285/v2_202409060916/en/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Clinical Research</span>"
    "titulo" => "Gamma Knife radiosurgery for the treatment of trigeminal neuralgia&#58; A single center-experience"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "225"
        "paginaFinal" => "232"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Mehmet Osman Akcakaya, Muyassar Mirkhasilova, Onur Ozturk, Doga Ugurlar, Mehmet Tonge, Gul Alco, Tulay Ercan, Sefik Igdem, Selhan Karadereler"
        "autores" => array:9 [
          0 => array:3 [
            "nombre" => "Mehmet Osman"
            "apellidos" => "Akcakaya"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Muyassar"
            "apellidos" => "Mirkhasilova"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:4 [
            "nombre" => "Onur"
            "apellidos" => "Ozturk"
            "email" => array:1 [
              0 => "onurozturk.ial@gmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              1 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Doga"
            "apellidos" => "Ugurlar"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Mehmet"
            "apellidos" => "Tonge"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Gul"
            "apellidos" => "Alco"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "aff0030"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Tulay"
            "apellidos" => "Ercan"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "aff0030"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Sefik"
            "apellidos" => "Igdem"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "aff0030"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "Selhan"
            "apellidos" => "Karadereler"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:6 [
          0 => array:3 [
            "entidad" => "Department of Neurosurgery&#44; Gayrettepe Florence Nightingale Hospital&#44; Istanbul&#44; Turkey"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Department of Neurosurgery&#44; Rami Hospital&#44; Istanbul&#44; Turkey"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Department of Neurosurgery&#44; Acibadem Taksim Hospital&#44; Istanbul&#44; Turkey"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Department of Neurosurgery&#44; Samatya Training and Research Hospital&#44; Istanbul&#44; Turkey"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Department of Neurosurgery&#44; Medipol Mega Hospital&#44; Istanbul&#44; Turkey"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
          5 => array:3 [
            "entidad" => "Department of Radiation Oncology&#44; Gayrettepe Florence Nightingale Hospital&#44; Istanbul&#44; Turkey"
            "etiqueta" => "f"
            "identificador" => "aff0030"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Radiocirug&#237;a Gamma-Knife para el tratamiento de la neuralgia del trig&#233;mino&#58; una experiencia en un solo centro"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1818
            "Ancho" => 1675
            "Tamanyo" => 226554
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">T1 weigthed MRI shows distal target selection to anterior cisternal portion of TGN&#46; Inner circle represent 50&#37; isodose line whereas outer circle represents 20&#37; isodose line&#46; Note that 20&#37; isodose line stays tangential to brainstem surface&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Trigeminal neuralgia &#40;TGN&#41; is considered as one of the most disturbing and painful conditions in humans&#46; TGN is a common syndrome characterized by episodic severe pain&#44; and the incidence is approximately 4&#46;3&#8211;8 per 100000&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Several treatments are available for patients with TGN&#44; including medical and surgical options&#46; Although the first treatment of choice is antiepileptic drugs&#44; &#62;50&#37; of the patients eventually require surgical intervention for pain relief&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The most commonly employed surgical procedures include open surgery &#91;microvascular decompression &#40;MVD&#41;&#93;&#44; percutaneous procedures &#40;percutaneous balloon compression&#44; percutaneous glycerol rhizotomy&#44; and radiofrequency thermocoagulation&#41; and radiosurgery&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Since the first report of radiosurgery for TGN by Lars Leksell with a prototype tool&#44; Gamma Knife radiosurgery &#40;GKRS&#41; has emerged as a minimal invasive method&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;8</span></a> Many prospective and retrospective studies have demonstrated the safety and efficacy of GKRS in TGN&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of the present study is to assess the long-term results and outcome of a series of TGN patients that underwent GKRS in a single center&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Material and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Patients</span><p id="par0020" class="elsevierStylePara elsevierViewall">Between May 2012 and December 2022&#44; 53 patients underwent radiosurgery in our gamma knife center&#46; Of these 53 patients&#44; 45 were successfully followed up and included to the study&#46; The eight patients excluded patients were lost to follow-up or they had a short follow-up &#40;&#60;6 months&#41;&#46; The mean age of the study patients was 59&#46;8&#160;&#177;&#160;11&#46;9 years &#40;range&#44; 34&#8211;85&#41;&#46; Of the 45 patients&#44; 18 &#40;40&#37;&#41; were man and 27 &#40;60&#37;&#41; were women&#46; The mean duration of the symptoms was 9&#46;53&#160;&#177;&#160;7&#46;2 years &#40;range&#44; 1&#8211;30 years&#41;&#46; All patients had a history of extensive medical treatment with multiple drugs&#46; Anticonvulsants such as carbamazepine&#44; gabapentin and phenytoin were the most commonly used drugs&#46; Four patients &#40;8&#46;9&#37;&#41; could not tolerate drugs&#39; side effects&#46; Twenty-four patients &#40;53&#46;3&#37;&#41; had a history of undergoing at least one surgery&#44; with a mean of 1&#46;92 surgical interventions&#46;Two of these 24 patients had a history of undergoing GKRS at another center&#46; Twenty-one patients &#40;46&#46;7&#37;&#41; had no history of undergoing any surgery&#46; All patients had typical TGN&#46; The right side was affected in 21 patients &#40;46&#46;7&#37;&#41;&#44; and the left side was affected in 24 patients &#40;53&#46;3&#37;&#41;&#46; In 14 patients &#40;31&#46;1&#37;&#41;&#44; a single trigeminal division was affected&#46; V2 affection was in 7 patients and V3 affection in 7 patients&#46; Sole V1 involvement was not detected &#40;<a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a>&#41;&#46; In 21 patients &#40;46&#46;7&#37;&#41; two different trigeminal divisions were affected &#40;46&#46;7&#37;&#59; V1&#8211;V2&#44; n &#61; 4 &#91;8&#46;9&#37;&#93;&#59; V2&#8211;V3&#44; n &#61; 17 &#91;37&#46;8&#37;&#93;&#41;&#44; and all three divisions were affected in 10 patients &#40;22&#46;2&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Operative technique</span><p id="par0025" class="elsevierStylePara elsevierViewall">All patients underwent GKRS&#46; A Leksell model G stereotactic frame &#40;Elekta Instruments AB&#44; Stockholm&#44; Sweden&#41; was applied under local anesthesia&#46; Thereafter&#44; magnetic resonance imaging &#40;MRI&#41; was performed for planning the treatment with Leksell GammaPlan &#40;Elekta Instruments AB&#44; Stockholm&#44; Sweden&#41;&#46; A stereotactic MRI &#40;non-gap continuous&#44; square matrix&#41; was performed to delineate trigeminal nerve&#44; and T2-weighted&#44; contrast-enhanced T1-weighted and constructive interference steady state &#40;CISS&#41; MRI sequences were obtained&#46; All the GKRS procedures were performed using Leksell Gamma Knife Perfexion &#40;Elekta Instruments AB&#44; Stockholm&#44; Sweden&#41;&#46; Dose selection and planning were performed by a neurological surgeon&#44; radiation oncologist and medical physicist&#46; A single 4-mm isocenter was used in all instances&#44; which is positioned to cover the anterior cisternal portion of the trigeminal nerve &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; or the root entry zone &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The anterior cisternal target was located 4&#8211;8&#46;3&#160;mm &#40;mean 5&#46;35&#160;&#177;&#160;1&#46;5&#160;mm&#41; anterior to the emergence of the nerve&#44; whereas the target for root entry zone target was located 1&#46;6&#8211;3&#46;9&#160;mm &#40;mean 2&#46;95&#160;&#177;&#160;0&#46;7&#160;mm&#41; anterior to the nerve emergence&#46; The dosage used ranged between 80 and 90&#160;Gy &#40;mean 87&#46;5&#160;&#177;&#160;2&#46;8&#160;Gy&#41;&#46; For the anterior cisternal and root entry zone targets&#44; the isocenter was positioned such that the brainstem surface stays tangential to 20&#37; and 50&#37; isodose lines&#44; respectively&#46; Furthermore&#44; beam channel blocking was used to prevent the 15&#160;Gy isodose line to cover &#60;5&#37; of brainstem&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Pain relief</span><p id="par0030" class="elsevierStylePara elsevierViewall">The patients were classified according to their degree of pain experienced using the Barrow Neurological Institute &#40;BNI&#41; Scale as follows&#58; Class I&#44; no pain&#44; no medication&#59; Class II&#44; occasional pain not requiring medication&#59; Class IIIa&#44; no pain&#44; but continued medication&#59; Class IIIb&#44; pain controlled with medication&#59; Class IV&#44; pain not adequately controlled with medication&#59; Class V&#44; no pain relief &#40;severe pain&#41;&#46; BNI score of I-IIIb were indicative of successful treatment&#44; and BNI scores of IV and V were considered as treatment failure&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The patients were followed up with clinical visits at three months&#44; six months and one year postoperatively&#46; They were then followed up annually&#46; Final treatment outcome was determined via direct conversations during control visits if possible&#44; or via telephonic interviews conducted by physicians who were not involved in patient selection or management&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">Data distribution was assessed using skewness and kurtosis tests&#46; After descriptive statistics were analyzed&#44; the categorical variables were analyzed using Pearson chi-square and Fisher&#8217;s exact tests&#46; The correlation between significant categorical variables studied using Pearson&#8217;s correlation test&#46; The independent <span class="elsevierStyleItalic">t</span>-test was used to compare the variable among various subgroups&#46; Interactions between the variables were examined using logistic regression test&#44; and the odds ratio for each factor was calculated&#46; All statistical analysis were conducted using SPSS &#40;version 25&#46;0&#46;&#44; SPSS Inc&#46;&#44;IBM&#44; Chicago&#44; IL&#44; USA&#41;&#46; A p value of &#60;0&#46;05 was considered statistically significant&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">Forty-five patients were followed-up by a mean time of 46&#46;8&#160;&#177;&#160;38&#46;5 months &#40;12&#8211;127 months&#41;&#46; The GKRS failed in nine patients &#40;&#37;20&#41;&#46; They did not experience significant pain relief even after 12 months of follow-up&#44; and they continued to have severe pain &#40;BNI Class V&#41;&#46; The initial success rate was 80&#37; &#40; n &#61; 36&#41;&#46; Among these 36 patients in whom a degree of pain control was achieved&#44; 27 patients &#40;60&#37;&#41; belonged to BNI Class I &#40;excellent pain control&#41;&#44; 1 &#40;2&#46;2&#37;&#41; belonged to BNI Class II&#44; 4 &#40;8&#46;9&#37;&#41; belonged to BNI Class IIIa and 4 &#40;8&#46;9&#37;&#41; belonged to BNI Class IIIb&#46; In total&#44; moderate pain control was achieved in eight patients &#40;17&#46;8&#37;&#41;&#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; Pain relief is achieved a mean 2&#46;01&#160;&#177;&#160;2&#46;1 months &#40;range 1 day to 10 months&#41; following GKRS&#46; After GKRS&#44; 30 patients &#40;66&#46;7&#37;&#41; experienced hypoesthesia in related dermatome&#46; The target choise did not affect the development of hypoesthesia &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;38&#41;&#46; Furthermore&#44; there were no significant difference in the distance from nerve emergence in the patients with and without hypoesthesia &#40;3&#46;95&#160;&#177;&#160;1&#46;69&#160;mm and 3&#46;57&#160;&#177;&#160;1&#46;17&#160;mm respectively&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;48&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">TGN reccured in 11 patients &#40;24&#46;4&#37;&#41;&#46; Mean duration to recurrence was 27&#46;6&#160;&#177;&#160;14&#46;9 months &#40;range&#44; 12&#8211;66&#41;&#46; Among the patients with TGN recurrence&#44; seven had BNI score of I&#44; one had a score of II&#44; two had a score of IIIa&#44; and one had a score of IIIb&#46; Two of the patients with recurrence &#40;4&#46;4&#37;&#41; deteriorated from BNI Class I to BNI Class II&#46; So&#44; these two patients still have a good pain control and they differ from the other patients who developed a recurrence&#46; At the end of the follow-up period&#44; 20 patients &#40;44&#46;4&#37;&#41; remained in the BNI Class I &#40;excellent pain control&#41;&#46; The mean follow-up of this subgroup was 72&#46;35&#160;&#177;&#160;38&#46;3 months &#40;range&#44; 15-127&#41;&#46; Eight patients &#40;17&#46;8&#37;&#41; remained in the BNI Class IIIa or IIIb &#40;moderate pain control&#41;&#46; At the end of the mean 46&#46;8 months follow-up&#44; excellent to moderate pain control was achieved in 31 patients &#40;68&#46;9&#37;&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The followings were considered the factors affecting the treatment success rate and recurrence&#58; age&#44; the segment of TGN&#44; history of previous surgery&#44; existence of multiple sclerosis&#44; TGN duration&#44; radiation dose&#44; and target distance from nerve emergence&#46; Statistical analysis revealed that the treatments&#39; success rate was not affected by target choice &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;35&#41;&#46; Furthermore&#44; the target distance from the nerve emergence did not change the success rate&#46; The mean distance in the success and failure group was 3&#46;85&#160;&#177;&#160;1&#46;63&#160;and 3&#46;59&#160;&#177;&#160;1&#46;08&#160;mm&#44; respectively &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;65&#41;&#46; The target choice is not determinative for recurrence rate&#46; The radiation dose was 87&#46;6&#160;&#177;&#160;2&#46;6&#160;and 87&#160;&#177;&#160;3&#46;4&#160;Gy in the treatment success and failure groups&#44; respectively &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;56&#41;&#46; Additionally&#44; there was no statistically significance between the patients exposed to a dose of 90&#160;Gy and those exposed a dose of &#60;90&#160;Gy &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;77&#41;&#46; At the end of the follow-up period&#44; the rate of permanent pain control was 55&#46;2&#37; and 56&#46;2&#37; when targeting the anterior cisternal portion and root entry zone of the nerve&#44; respectively &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;56&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Comparing to the other factors&#44; the history of previous surgery demonstrated medium statistical significance as a predictor of both treatment failure &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;002 and <span class="elsevierStyleItalic">R</span>&#160;&#61;&#160;0&#46;47&#41; and recurrence &#40; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;002 and <span class="elsevierStyleItalic">R</span>&#160;&#61;&#160;0&#46;54&#41;&#46; &#40;&#46; A younger age was also a statistically significant predictor a recurrence &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;01&#41;&#46; In our study&#44; surgical intervention for TGN was preferred for younger patients &#40;56&#46;3&#160;&#177;&#160;11&#46;8 and 63&#46;8&#160;&#177;&#160;10&#46;9 years old&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;03&#41;&#46; Regression model analysis revealed that age was not a significant predictor of recurrence &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;18&#41; &#44; whereas a history of previous surgery was a significant predictor &#40; &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;02&#41; &#40;OR&#58; 0&#46;11 &#40;95&#37;CI&#58; 0&#46;017&#8722;0&#46;739&#41;&#46; Regression model analysis also revealed that the disease duration was not determinant of history of previous surgery&#40; &#40;8&#46;64&#160;&#177;&#160;7&#46;3 vs 12&#46;9&#160;&#177;&#160;8 years&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;16&#41; or the recurrence &#40;8&#46;64&#160;&#177;&#160;7&#46;3 vs 8&#46;82&#160;&#177;&#160;5&#46;9 years&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;95 &#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">Since the first case report of TGN treated with radiosurgery using a prototype guiding device linked to a dental X-ray machine by Lars Leksell in 1971&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and Lindquist&#8217;s publication on the progress of TGN patients following GKRS in 1991&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> GKRS has become an established surgical treatment modality for medically refractory TGN&#46; Due to its minimally invasive nature and very low complication rates&#44; it is currently considered a treatment option initially as well as for disease recurrence&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;11&#8211;13</span></a> Although there are no randomized controlled trials that have compared the efficacy of GKRS and other surgical procedures&#44; other studies indicate that they provide similar success rates&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Young individuals with minimal comorbidities are eligible for MVD surgery as a first line of treatment&#44; especially in patients with microvascular conflict&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> MVD provides a higher initial success rates &#40;approximately 90&#37;&#41; as well as highest long-term pain control &#40;61&#8211;88&#37; after 10 years&#41; than GKRS&#46; However&#44; MVD is a posterior fossa surgery&#44; which may be associated with major complications such as cerebrospinal fluid leakage&#44; hearing loss&#44; hydrocephalus&#44; extraocular muscle palsy&#44; facial palsy&#44; cerebellar edema&#44; aseptic or bacterial meningitis&#44; hemorrhage&#44; brainstem infarction and&#44; and rarely&#44; even death&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;8&#44;12&#44;14</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Percutaneous procedures provide an initial success rates of 73&#37; to 100&#37; and a recurrence free interval of 20&#8211;22 months&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Percutaneous ablative procedures are associated with morbidities such as hypoesthesia&#44; dysesthesia&#44; corneal keratitis&#44; masseter muscle weakness and anesthesia dolorosa&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> However&#44; GKRS is generally associated with only mild complications&#44; including trigeminal nerve sensory disturbance&#44; which is related with dose and target location&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The brainstem irradiation dose and the length of the irradiated nerve segment are the other predisposing factors&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Most patients do not find this complication disabling or bothersome&#44; and consider as a good tradeoff for pain relief&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> Post-GKRS hypoesthesia in the trigeminal nerve distribution is predictive of pain relief&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">15</span></a> making it a &#8220;desired&#8221; postoperative complication&#46; Regis et al&#46; reported only 11 cases &#40;2&#46;2&#37;&#41; of bothersome facial numbness in their study of 497 patients&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Prk et al&#46; reported dysesthesia &#40;1&#46;4&#37;&#41; and dry eye syndrome &#40;2&#46;8&#37;&#41; following GKRS&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> No other complications have been reported following GKRS for TGN&#46; According to Urgosik et al&#46;&#44; TGN sensory disturbance is the only significant post-GKRS side effect in clinical practice&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">16</span></a> Similar to the findigns of previous publications&#44; postoperative numbness or hypoesthesia was the only post-GKRS complication in our study &#40;n &#61; 30&#59; 66&#46;7&#37;&#41;&#46; No other complications were encountered&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Various studies have reported an initial success rate&#44; in terms of pain relief&#44; of 70&#37; to 98&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Kondziolka et al&#46;&#44; Regis et al&#46;&#44; Marshall et al&#46;&#44; and Lucas et al&#46;reported 89&#37; pain relief in 503 patients&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> 91&#46;75&#37; in 497 patients&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> 86&#37; in 448 patients<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">17</span></a>&#44; and 84&#46;5&#37; in 446 patients<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">18</span></a>&#44; respectively&#46; Although having a slight lower initial success rate compared to these four largest series in the published literature&#44; our study demostrates an 80&#37; pain relief in 45 patients&#46; Exellent pain control was achieved in 60&#37; of the patients &#40;BNI score I&#41;&#44; and moderate pain control was achieved in 20&#37; &#40;BNI scores II&#44; IIIa and IIIb&#41;&#46; Among these patients&#44; 20 patients &#40;44&#46;4&#37;&#41; remained pain- and drug-free for a mean of 72&#46;4 months&#46; Fourteen of these 20 patients &#40;70&#37;&#41;&#160;had not previously undergone surgery&#46; Thus&#44; GKRS might provide a much longer pain-free follow-up as the first line of treatment&#46; As our statistical analysis revealed&#44; the history of previous surgery was a significant factor influencing both recurrence and initial failure rates&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Other surgical treatments prior to GKRS are associated with lesser pain relief&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">19</span></a> Additionally&#44; failure of one surgical treatment reduced the expectation of complete pain relief&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> We found a significant correlation between the initial success rate and the absence of a previous surgical intervention&#46; In the study by Regis et al&#46;&#44; 65&#46;2&#37; of 497 patients had no history of previous surgery&#46; They found that GKRS was a rational first line of treatment for TGN&#44; considering itsminimally invasive nature&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> In different publications&#44; two or more surgeries was associated with treatment failure or higher recurrence rates&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;11</span></a> Therefore&#44; we believe that GKRS is a safe and efficient primary treatment for TGN&#44; which produces pain control for a sufficient duration&#46; However&#44; prospective controlled randomized studies with greater sample size must be conducted to validate our findings&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Although the pathophysiology of TGN is not fully understood&#44; both central and peripheral mechanisms were considered in pathogenesis&#46; Neurovascular compression due to aberrant blood vessel loops in the cisternal segment of trigeminal nerve is most frequently responsible for TGN&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13&#44;20</span></a> Chronic neurovascular compression causes demyelination of the sensory fibers within the proximal nerve root&#44; which leads to hyperexcitability and clinical symptoms&#46; GKRSmost probably causes ionic channel blockage&#47;destruction in addition to focal axonal degeneration&#44; which reduces paroxysms and pain&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;21&#44;22</span></a> Additionally&#44; irradiation is presumed to be responsible for delayed axonal degeneration&#44; which may account for the significant amount of patients experiencing late pain relief&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">23</span></a> Regis et al&#46; reported a median latency of 10 days &#40;range&#44; 1&#8211;180 days&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> whereas Kondziolka et al&#46; reported a median latency of 1 month &#40;range&#44; 1 day&#8211;1&#160;year&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Although current studies report a latency of 15&#8211;78 days after GKRS until pain relief&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">24</span></a> a latency of up to 6 months even 1&#160;year has been reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a> In our study&#44; the mean latency period was 2 months &#40;range&#44; 1 day&#8211;10 months&#41;&#44; which is similar to the findings in literature&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Another significant parameter&#44; which might affect the outcomes&#44; is the target selection&#46; The trigeminal root entry zone is the transition zone between the peripheral and central myelinization&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">25</span></a> Oligodendrocytes are more radiosensitivethan Schwann cells&#44; which are responsible of peripheral myelinization&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Therefore&#44; targeting the root entry zone may result in superior pain relief&#44; which is associated with the greater brainstem volumes receiving higher irridation doses&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;20&#44;21</span></a> However&#44; some studies propose that targeting the anterior cisternal portionreduces the doses to the brainstem and the associated complications&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">26</span></a> Targeting the distal portion of the nerve is as effective as targeting the proximal portion in producing pain relief&#46; Furthermore&#44; the complication rates are lower when targeting the distal target&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;20</span></a> In our study&#44; the neurosurgeons &#40;MOA&#44; DU&#44; SK&#41; chose the target according to their own understanding of the disease and treatment strategy&#46; Our retrospective study spanned 10 years&#44; and included both anterior cisternal portion and the root entry zone as targets&#46; We did not find any significant association between target selection and outcomes in this wide period&#46; Although proximal target selection reportedly significantly affects the development of post-GKRS hypoesthesia&#44;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">27&#44;28</span></a> we did not find a difference in hypoesthesia development between proximal and distal targeting&#46; This may be attributed to the fact that patients were partially interviewed telephonically regarding their latest clinical condition&#44; as mentioned by Urgosik et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">16</span></a> The limited number of patients may have also played a role in this result&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Previous studies have demostrated that the doses of &#60;70&#160;Gy do not relieve TGN-related pain&#44; and they produce a limited structural effect on the trigeminal nerve&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">29&#44;30</span></a> Doses of &#62;80&#160;Gy might cause partial degeneration with axonal degeneration and demyelination&#44; which is associated with pain relief&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">30</span></a> Although doses of &#62;90&#160;Gy produces similar pain relief&#44; it is associated with higher complication rates&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a> Therefore&#44; a dose between 80 and 90&#160;Gy is generally used&#46; We administered 80&#160;Gy to only two patients&#44; who experienced moderate pain relief and initial failure&#44; respectively&#46; However&#44; this finding cannot be solely attributed to the treatment dose because of the limited number of patients and numerous associated factors&#46; In the remaining 43 patients&#44;a dose of 85to 90&#160;Gy were used&#46; We did not find any correlation between the treatment dose and outcome&#46; Similarly&#44; we did not find any statistically significant relation with the treatment dose and complications&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Recurrence rates in the published literature vary greatly&#46; In one study&#44; recurrence rate was 3&#46;3&#37; within a relatively short-term follow-up of 19&#46;8 months&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">31</span></a> Recently&#44; Zhao et al&#46; reported a recurrence rate of 3&#46;6&#37; in 49&#46;7 months&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">32</span></a> However&#44; higher recurrence rates were reported in some series with shorter follow-up&#46; Kondziolka et al&#46; reported a recurrence rate of 42&#46;9&#37; among 503 patients in 24 months&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Lucas et al&#46; reported a recurrence rate of 45&#46;6&#37; among 446 patients in 21&#46;2 months&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">18</span></a> In our study&#44; the recurrence rate was 27&#46;5&#37; within 46&#46;8 months&#44; which was similar to the findings of previous studies in which the recurrence rate was 25&#8211;31&#46;2&#37; within 30&#8211;64&#46;7 months&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">16&#44;33&#44;34</span></a> The statistically significant factors affecting recurrence rates were younger age and a history of previous surgeries&#46; However&#44; regression model analysis revealed that a history of the previous surgeries was the only statistically significant factor&#59; the statistical significance of age was diminshed&#46; Additionally&#44; we found a correlation between younger age and increased number of previous surgeries&#46; There is a tendency of more aggressive selection of surgical options in the management of younger patients&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> whereas elderly patients were commonly managed with conservative medical treatment&#46; As a result of it&#44; there was overlapping in history of previous surgeries and younger age in our study&#46; We believe this explains why we identified younger age as a significant factor in recurrence rates during the single-factor analysis&#44; but the regression model excluded younger age as a recurrence factor by detecting this co-occurrence&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">This study had several limitations&#46; First&#44; despite the considerably long follow-up period&#44; the sample size is relatively small&#44; the treatment was performed on different targets with different doses&#46; Second&#44; this is a retrospective study&#46; Although we had not initally aimed to compare the different treatment groups&#44; we attempted to draw some calculations using the data collected&#46; Third&#44; most patients were interviewed telephonically to determine their latest condition&#46; There may be some subjectivity involved&#44; as certain complaints that seem unimportant to the patientmay be significant for the physician&#44; such as the presence of hypoesthesia&#46; If the patient did not mention it or attribute importance to it&#44; it cannot be reported&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusion</span><p id="par0115" class="elsevierStylePara elsevierViewall">GKRS is a safe and efficient method to manage medically refractory trigeminal neuralgia both as a primary or non-primary treatment option&#46; Despite all the precautions&#44; sensory impairment may occur following the procedure&#46; However&#44; GKRS is associated with better pain control in long term&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Funding</span><p id="par0120" class="elsevierStylePara elsevierViewall">No funding&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflict of interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">Mehmet Osman Akcakaya&#44; Muyassar Mirkhasilova&#44; Onur Ozturk&#44; Doga Ugurlar&#44; Mehmet Tonge&#44; Gul Alco&#44; Tulay Ercan&#44; Sefik Igdem and Selhan Karadereler declare that they have no conflict of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:13 [
        0 => array:3 [
          "identificador" => "xres2236868"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Introduction and objectives"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Materials and methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1872191"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "xpalclavsec1872190"
          "titulo" => "Abbreviations"
        ]
        3 => array:3 [
          "identificador" => "xres2236869"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Introducci&#243;n y objetivos"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Materiales y M&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        4 => array:2 [
          "identificador" => "xpalclavsec1872192"
          "titulo" => "Palabras clave"
        ]
        5 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        6 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Material and methods"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Patients"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Operative technique"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Pain relief"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Results"
        ]
        8 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Discussion"
        ]
        9 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Conclusion"
        ]
        10 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Funding"
        ]
        11 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Conflict of interest"
        ]
        12 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2023-11-16"
    "fechaAceptado" => "2024-03-20"
    "PalabrasClave" => array:2 [
      "en" => array:2 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1872191"
          "palabras" => array:4 [
            0 => "Trigeminal neuralgia"
            1 => "Gamma Knife"
            2 => "Radiosurgery"
            3 => "Outcome"
          ]
        ]
        1 => array:4 [
          "clase" => "abr"
          "titulo" => "Abbreviations"
          "identificador" => "xpalclavsec1872190"
          "palabras" => array:10 [
            0 => "BNI Scale"
            1 => "CISS"
            2 => "GKRS"
            3 => "MRI"
            4 => "MS"
            5 => "MVD"
            6 => "PBC"
            7 => "PGR"
            8 => "RF"
            9 => "TGN"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1872192"
          "palabras" => array:4 [
            0 => "Neuralgia del trig&#233;mino"
            1 => "Gamma-Knife"
            2 => "Radiocirug&#237;a"
            3 => "Resultado"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objectives</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We aimed to assess the outcomes of patients with trigeminal neuralgia &#40;TGN&#41; who underwent Gamma Knife radiosurgery &#40;GKRS&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Fifty-three patients with typical TGN underwent GKRS from May 2012 until December 2022&#46; Among these patients&#44; 45 patients who were follow-up for at least 12 months were included in the study&#46; A mean dose of 87&#46;5&#160;Gy &#40;range&#44; 80&#8211;90&#41; was administered to the trigeminal nerve&#46; Postoperatively&#44; outcome was considered excellent if the patient was pain- and medication-free&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The mean symtpom duration was 9&#46;53 years&#44; and the mean patient age was 59&#46;8 years &#40;range&#44; 34&#8211;85&#41;&#46; The mean follow-up period was 46&#46;8 months &#40;range&#44; 12&#8211;127 months&#41;&#46; 46&#46;7&#37; of patients had a history of previous surgical interventions&#46; A single nerve division was affected in 14 patients &#40;31&#46;1&#37;&#41;&#44; and multiple divisions were affected in 31 patients &#40;68&#46;9&#37;&#41;&#46; The rate of initial pain relief was 80&#37;&#46; Hypoesthesia in the area of trigeminal nerve developed in 30 &#40;66&#46;7&#37;&#41;&#46; Twenty patients &#40;44&#46;4&#37;&#41; exhibited excellent results within 72&#46;4 months&#46; Recurrence occurred in 11 patients &#40;24&#46;4&#37;&#41; with 27&#46;6 months&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Our results suggest that GKRS is a safe and effective procedure&#46; Thus&#44; it is an attractive first- and second-line treatment choice for TGN&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction and objectives"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Materials and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n y objetivos</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Nuestro objetivo fue evaluar los resultados de los pacientes con neuralgia del trig&#233;mino &#40;TGN&#41; que se sometieron a radiocirug&#237;a con Gamma Knife &#40;GKRS&#41;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y M&#233;todos</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Cincuenta y tres pacientes con TGN tipica se sometieron a GKRS entre mayo de 2012 y diciembre de 2022&#46; Entre estos pacientes&#44; se incluyeron al estudio 45 pacientes que fueron seguidos durante al menos 12 meses&#46; Se administr&#243; una dosis media de 87&#44;5 Gy &#40;rango&#44; 80-90&#41; al nervio trig&#233;mino&#46; El resultado postoperatorio se consider&#243; excelente si el paciente no padec&#237;a dolor ni medicaci&#243;n&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">La duraci&#243;n media de los s&#237;ntomas fue de 9&#44;53 a&#241;os y la edad media de los pacientes fue de 59&#44;8 &#40;rango&#44; 34 a 85&#41;&#46; El per&#237;odo medio de seguimiento fue de 46&#44;8 meses &#40;rango&#44; 12-127 meses&#41;&#46; El 46&#44;7&#37; de los pacientes ten&#237;a antecedentes de intervenciones quir&#250;rgicas previas&#46; Una sola divisi&#243;n nerviosa se vio afectada en 14 pacientes &#40;31&#44;1&#37;&#41; y multiples divisiones en 31 pacientes &#40;68&#44;9&#37;&#41;&#46; La tasa de alivio del dolor inicial fue del 80&#37;&#46; La hipoestesia en el &#225;rea de distribuci&#243;n del nervio trig&#233;mino se desaroll&#243; en 30 pacientes &#40;66&#44;7&#37;&#41;&#46;Viente pacientes &#40;44&#44;4&#37;&#41; mostraron excelentes resultados en 72&#44;4 meses&#46; La recurrencia se desaroll&#243; en 11 pacientes &#40;24&#44;4&#37;&#41; con 27&#44;6 meses&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Nuestros resultados sugieren que GKRS es un procedimiento seguro y eficaz&#46; Por tant&#305;&#44; es una opci&#243;n atractiva de primera y segunda l&#237;nea para la TGN&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n y objetivos"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Materiales y M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "multimedia" => array:5 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1082
            "Ancho" => 1675
            "Tamanyo" => 171511
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">CISS MRI shows proximal target selection to REZ of TGN&#46; Inner circle &#40;yellow&#41; represents 50&#37; isodose line and outer circle &#40;green&#41; represents 20&#37; isodose line&#46; Note that 50&#37; isodose line stays tangential to brainstem surface&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1818
            "Ancho" => 1675
            "Tamanyo" => 226554
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">T1 weigthed MRI shows distal target selection to anterior cisternal portion of TGN&#46; Inner circle represent 50&#37; isodose line whereas outer circle represents 20&#37; isodose line&#46; Note that 20&#37; isodose line stays tangential to brainstem surface&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0015"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:2 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Success</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Failure</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age &#40;year&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Duration of symptoms &#40;year&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3645907.png"
              ]
            ]
            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sex</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Side</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Right&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Left&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Segment</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>V1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>V2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>V3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>V1-V2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>V2-V3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>V1-V2-V3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3645909.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Demographics&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0020"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Present</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Absent</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total <span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span>&#47;<span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Previous Surgery</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Radiofrequency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Balloon compression&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Glycerol injection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Microvascular decompression&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Gamma Knife&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3645906.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Previous surgery&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0025"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">BNI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">I</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">II</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IIIa</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IIIb</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IV</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">V</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Early control&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Final control&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3645908.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Early and final BNI scale&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:34 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence and clinical features of trigeminal neuralgia&#44; Rochester&#44; Minnesota&#44; 1945-1984"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Katusic"
                            1 => "C&#46;M&#46; Beard"
                            2 => "E&#46; Bergstralh"
                            3 => "L&#46;T&#46; Kurland"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ana.410270114"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Neurol"
                        "fecha" => "1990"
                        "volumen" => "27"
                        "paginaInicial" => "89"
                        "paginaFinal" => "95"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2301931"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The incidence and lifetime prevalance of neurological disorders in a community-based study in the UK"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "B&#46;K&#46; MacDonald"
                            1 => "O&#46;C&#46; Cockerell"
                            2 => "J&#46;W&#46; Sander"
                            3 => "S&#46;D&#46; Shorvon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/brain/123.4.665"
                      "Revista" => array:7 [
                        "tituloSerie" => "Brain"
                        "fecha" => "2000"
                        "volumen" => "123"
                        "numero" => "Pt 4"
                        "paginaInicial" => "665"
                        "paginaFinal" => "676"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10733998"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The long term outcome of microvascular decompression for trigeminal neuralgia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "F&#46;G&#46; Barker 2<span class="elsevierStyleSup">nd</span>"
                            1 => "P&#46;J&#46; Jannetta"
                            2 => "D&#46;J&#46; Bissonette"
                            3 => "M&#46;V&#46; Lerkins"
                            4 => "H&#46;D&#46; Jho"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "N Eng J Med"
                        "fecha" => "1996"
                        "volumen" => "334"
                        "paginaInicial" => "1077"
                        "paginaFinal" => "1083"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cerebral radiosurgery&#46; I&#46; Gammathalanotomy in two cases of intractable pain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "L&#46; Leksell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Chir Scand"
                        "fecha" => "1968"
                        "volumen" => "134"
                        "paginaInicial" => "585"
                        "paginaFinal" => "595"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5713443"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sterotaxic radiosurgery in trigeminal neuralgia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "L&#46; Leksell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Chir Scand"
                        "fecha" => "1971"
                        "volumen" => "137"
                        "paginaInicial" => "311"
                        "paginaFinal" => "314"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4948331"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Stereotactic radiosurgery for trigeminal neuralgia&#58; a multiinstitutional study using the gamma unit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Kondziolka"
                            1 => "L&#46;D&#46; Lunsford"
                            2 => "J&#46;C&#46; Flickinger"
                            3 => "R&#46;F&#46; Young"
                            4 => "S&#46; Vermeulen"
                            5 => "C&#46;M&#46; Duma"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3171/jns.1996.84.6.0940"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Neurosurg"
                        "fecha" => "1996"
                        "volumen" => "84"
                        "numero" => "6"
                        "paginaInicial" => "940"
                        "paginaFinal" => "945"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8847587"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Leksell Gamma Knife treatment of tic douloureux"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46;W&#46; Rand"
                            1 => "D&#46;B&#46; Jacques"
                            2 => "R&#46;W&#46; Melbye"
                            3 => "B&#46;G&#46; Coppcutt"
                            4 => "M&#46;N&#46; Levenick"
                            5 => "M&#46;R&#46; Fisher"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000100663"
                      "Revista" => array:7 [
                        "tituloSerie" => "Stereotact Funct Neurosurg"
                        "fecha" => "1993"
                        "volumen" => "61"
                        "numero" => "Suppl 1"
                        "paginaInicial" => "93"
                        "paginaFinal" => "102"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8115760"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Longterm safety and efficacy of Gamma Knife surgery in classical trigeminal neuralgia&#58; a 497-patient historical cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Regis"
                            1 => "C&#46; Tuleasca"
                            2 => "N&#46; Resseguier"
                            3 => "R&#46; Carron"
                            4 => "A&#46; Donnet"
                            5 => "J&#46; Gaudart"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3171/2015.2.JNS142144"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Neurosurg"
                        "fecha" => "2016"
                        "volumen" => "124"
                        "numero" => "4"
                        "paginaInicial" => "1079"
                        "paginaFinal" => "1087"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26339857"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gamma Knife surgery in trigeminal neuralgia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Wolf"
                            1 => "D&#46; Kondziolka"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.nec.2016.02.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurosurg Clin N Am"
                        "fecha" => "2016"
                        "volumen" => "27"
                        "paginaInicial" => "297"
                        "paginaFinal" => "304"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27324996"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Functional neurosurgery-a future for the gamma knife&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Lindquist"
                            1 => "L&#46; Kihlstr&#246;m"
                            2 => "E&#46; Hellstrand"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000099557"
                      "Revista" => array:6 [
                        "tituloSerie" => "Stereotact Funct Neurosurg"
                        "fecha" => "1991"
                        "volumen" => "57"
                        "paginaInicial" => "72"
                        "paginaFinal" => "81"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1725560"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gamma Knife stereotactic radiosurgery for idiopathic trigeminal neuralgia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Kondziolka"
                            1 => "O&#46; Zorro"
                            2 => "J&#46; Lobato-Polo"
                            3 => "H&#46; Kano"
                            4 => "T&#46;J&#46; Flannery"
                            5 => "J&#46;C&#46; Flickinger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3171/2009.7.JNS09694"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Neurosurg"
                        "fecha" => "2010"
                        "volumen" => "112"
                        "paginaInicial" => "758"
                        "paginaFinal" => "765"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19747055"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gamma Knife radiosurgery on the trigeminal root entry zon efor idiopathic trigeminal neuralgia&#58; Results and review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;H&#46; Park"
                            1 => "J&#46;W&#46; Chang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3349/ymj.2020.61.2.111"
                      "Revista" => array:7 [
                        "tituloSerie" => "Yonsei Med J"
                        "fecha" => "2020"
                        "volumen" => "61"
                        "numero" => "2"
                        "paginaInicial" => "111"
                        "paginaFinal" => "119"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31997619"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bibliometric analysis of the top 100 cited articles on stereotactic radiosurgery for trigeminal neuralgia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Parikh"
                            1 => "H&#46;M&#46; Abdallah"
                            2 => "A&#46; Patel"
                            3 => "R&#46;K&#46; Shariff"
                            4 => "K&#46;W&#46; Nowicki"
                            5 => "A&#46;N&#46; Mallela"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-0043-1761240"
                      "Revista" => array:7 [
                        "tituloSerie" => "Asian J Neurosurg"
                        "fecha" => "2023"
                        "volumen" => "18"
                        "numero" => "1"
                        "paginaInicial" => "101"
                        "paginaFinal" => "107"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/37056872"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The efficacy and safety of microvascular decompression for idiopathic trigeminal neuralgia in patients older than 65 years"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46;B&#46; Yang"
                            1 => "Z&#46;M&#46; Wang"
                            2 => "D&#46;Y&#46; Jiang"
                            3 => "H&#46;C&#46; Chen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/SCS.0000000000000869"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Craniofac Surg"
                        "fecha" => "2014"
                        "volumen" => "25"
                        "paginaInicial" => "1393"
                        "paginaFinal" => "1396"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24816027"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of various surgical modalities in recurrent or persistent trigeminal neuralgia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46; Han"
                            1 => "D&#46; Shin"
                            2 => "J&#46; Chang"
                            3 => "K&#46; Kim"
                            4 => "J&#46; Chang"
                            5 => "R&#46; Huh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000303530"
                      "Revista" => array:7 [
                        "tituloSerie" => "Stereotact Funct Neurosurg"
                        "fecha" => "2010"
                        "volumen" => "88"
                        "numero" => "3"
                        "paginaInicial" => "156"
                        "paginaFinal" => "162"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20357523"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of essential trigeminal neuralgia with gamma knife surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46; Urgosik"
                            1 => "R&#46; Liscak"
                            2 => "J&#46; Novotny"
                            3 => "J&#46; Vymazal"
                            4 => "V&#46; Vladyka"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Neurosurg &#40;Suppl&#41;"
                        "fecha" => "2005"
                        "volumen" => "102"
                        "paginaInicial" => "29"
                        "paginaFinal" => "33"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictive variables for the successful treatment of trigeminal neuralgia with gamma knife radiosurgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Marshall"
                            1 => "M&#46;D&#46; Chan"
                            2 => "T&#46;P&#46; McCoy"
                            3 => "A&#46;C&#46; Aubuchon"
                            4 => "J&#46;D&#46; Bourland"
                            5 => "K&#46;P&#46; McMullen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1227/NEU.0b013e3182320d36"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurosurgery"
                        "fecha" => "2012"
                        "volumen" => "70"
                        "paginaInicial" => "566"
                        "paginaFinal" => "573"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21849918"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictive nomogram for the durability of pain relief from gamma knife radiation surgery in the treatment of trigeminal neuralgia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;T&#46; Lucas Jr"
                            1 => "A&#46;M&#46; Nida"
                            2 => "S&#46; Isom"
                            3 => "K&#46; Marshall"
                            4 => "J&#46;D&#46; Bourland"
                            5 => "A&#46;W&#46; Laxton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijrobp.2014.01.023"
                      "Revista" => array:7 [
                        "tituloSerie" => "Int J Radiat Oncol Biol Phys"
                        "fecha" => "2014"
                        "volumen" => "89"
                        "paginaInicial" => "120"
                        "paginaFinal" => "126"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24613811"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1529943013013910"
                          "estado" => "S300"
                          "issn" => "15299430"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gamma knife radiosurgery for trigeminal neuralgia&#58; dose-volume histograms of the brainstem and trigeminal nerve"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46; Brisman"
                            1 => "R&#46; Mooij"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3171/jns.2000.93.supplement"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Neurosurg"
                        "fecha" => "2000"
                        "volumen" => "93"
                        "numero" => "1 Suppl 3"
                        "paginaInicial" => "155"
                        "paginaFinal" => "158"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11143235"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gamma knife radiosurgery for trigeminal neuralgia&#58; first case series from Latin America"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Constanzo"
                            1 => "R&#46;S&#46;D&#46; Silva"
                            2 => "D&#46;B&#46; de Almeida"
                            3 => "M&#46;A&#46; Ferragut"
                            4 => "M&#46; Coelho Neto"
                            5 => "H&#46;V&#46; Toledo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/0004-282X20190027"
                      "Revista" => array:7 [
                        "tituloSerie" => "Arq Neuropsiquiatr"
                        "fecha" => "2019"
                        "volumen" => "77"
                        "numero" => "4"
                        "paginaInicial" => "232"
                        "paginaFinal" => "238"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31090803"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Histological effects of trigeminal nerve radiosurgery in a primate model&#58; implications for trigeminal neuralgia radiosurgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Kondziolka"
                            1 => "D&#46; Lacomis"
                            2 => "A&#46; Niranjan"
                            3 => "Y&#46; Mori"
                            4 => "S&#46; Maesawa"
                            5 => "W&#46; Fellows"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00006123-200004000-00038"
                      "Revista" => array:7 [
                        "tituloSerie" => "Neurosurgery"
                        "fecha" => "2000"
                        "volumen" => "46"
                        "numero" => "4"
                        "paginaInicial" => "971"
                        "paginaFinal" => "976"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10764273"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Radiation mechanisms of pain control in classical trigeminal neuralgia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Gorgulho"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/2152-7806.92931"
                      "Revista" => array:7 [
                        "tituloSerie" => "Surg Neurol Int"
                        "fecha" => "2012"
                        "volumen" => "3"
                        "numero" => "2 Suppl 1"
                        "paginaInicial" => "17"
                        "paginaFinal" => "25"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22439108"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical outcomes after stereotactic radiosurgery for idiopathic trigeminal neuralgia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46; Maesawa"
                            1 => "C&#46; Salame"
                            2 => "J&#46;C&#46; Flickinger"
                            3 => "S&#46; Pirris"
                            4 => "D&#46; Kondziolka"
                            5 => "L&#46;D&#46; Lunsford"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3171/jns.2001.94.1.0014"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Neurosurg"
                        "fecha" => "2001"
                        "volumen" => "94"
                        "paginaInicial" => "14"
                        "paginaFinal" => "20"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11147887"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Stereotactic radiosurgery for trigeminal neuralgia&#58; a systematic review&#58; International Stereotactic Radiosurgery Society Practice Guidelines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Tuleasca"
                            1 => "J&#46; R&#233;gis"
                            2 => "A&#46; Sahgal"
                            3 => "A&#46; De Salles"
                            4 => "M&#46; Hayashi"
                            5 => "L&#46; Ma"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3171/2017.9.JNS17545"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Neurosurg"
                        "fecha" => "2018"
                        "volumen" => "130"
                        "paginaInicial" => "733"
                        "paginaFinal" => "757"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29701555"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Varying length of central myelin along the trigeminal nerve might contribute to trigeminal neuralgia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "K&#46; Nomura"
                            1 => "H&#46; Ryu"
                            2 => "K&#46; Ohno"
                            3 => "K&#46; Sato"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ca.23348"
                      "Revista" => array:7 [
                        "tituloSerie" => "Clin Anat"
                        "fecha" => "2019"
                        "volumen" => "32"
                        "numero" => "04"
                        "paginaInicial" => "541"
                        "paginaFinal" => "545"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30719770"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gamma knife surgery for idiopathic trigeminal neuralgia performed using a far-anterior cisternal target and a high dose of radiation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "N&#46; Massager"
                            1 => "J&#46; Lorenzoni"
                            2 => "D&#46; Devriendt"
                            3 => "F&#46; Desmedt"
                            4 => "J&#46; Brotchi"
                            5 => "M&#46; Levivier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3171/jns.2004.100.4.0597"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Neurosurg"
                        "fecha" => "2004"
                        "volumen" => "100"
                        "numero" => "4"
                        "paginaInicial" => "597"
                        "paginaFinal" => "605"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15070111"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High-dose trigeminal neuralgia radiosurgery associated with increased risk of trigeminal nerve dysfunction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "B&#46;E&#46; Pollock"
                            1 => "L&#46;K&#46; Phuong"
                            2 => "R&#46;L&#46; Foote"
                            3 => "S&#46;L&#46; Stafford"
                            4 => "D&#46;A&#46; Gorman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00006123-200107000-00008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurosurgery"
                        "fecha" => "2001"
                        "volumen" => "49"
                        "paginaInicial" => "58"
                        "paginaFinal" => "64"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11440460"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prospective controlled trial of gamma knife surgery for essential trigeminal neuralgia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Regis"
                            1 => "P&#46; Metellus"
                            2 => "M&#46; Hayashi"
                            3 => "P&#46; Roussel"
                            4 => "A&#46; Donnet"
                            5 => "F&#46; Bille-Turc"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3171/jns.2006.104.6.913"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Neurosurg"
                        "fecha" => "2006"
                        "volumen" => "104"
                        "numero" => "6"
                        "paginaInicial" => "913"
                        "paginaFinal" => "924"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16776335"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gamma knife radiosurgery for trigeminal neuralgia&#58; a study of predictors of success&#44; efficacy&#44; safety&#44; and outcome at LSUHSC"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Shaya"
                            1 => "A&#46; Jawahar"
                            2 => "G&#46; Caldito"
                            3 => "A&#46; Sin"
                            4 => "B&#46;K&#46; Willis"
                            5 => "A&#46; Nanda"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.surneu.2003.11.027"
                      "Revista" => array:6 [
                        "tituloSerie" => "Surg Neurol"
                        "fecha" => "2004"
                        "volumen" => "61"
                        "paginaInicial" => "529"
                        "paginaFinal" => "534"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15165787"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gamma Knife irradiation-induced histopathological changes in the trigeminal nerves of rhesus monkeys"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "Z&#46;F&#46; Zhao"
                            1 => "L&#46;Z&#46; Yang"
                            2 => "C&#46;L&#46; Jiang"
                            3 => "Y&#46;R&#46; Zheng"
                            4 => "J&#46;W&#46; Zhang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Neurosurg"
                        "fecha" => "2010"
                        "volumen" => "113"
                        "paginaInicial" => "39"
                        "paginaFinal" => "44"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21218532"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gamma knife radiosurgery for the treatment of trigeminal neuralgia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;F&#46; Young"
                            1 => "S&#46; Vermulen"
                            2 => "A&#46; Posewitz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000056422"
                      "Revista" => array:7 [
                        "tituloSerie" => "Stereotact Funct Neurosurg"
                        "fecha" => "1998"
                        "volumen" => "70"
                        "numero" => "Suppl 1"
                        "paginaInicial" => "192"
                        "paginaFinal" => "199"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9782251"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcomes of two-isocenter gamma knife radiosurgery for patients with typical trigeminal neuralgia&#58; pain response and quality of life"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "H&#46; Zhao"
                            1 => "Y&#46; Shen"
                            2 => "D&#46; Yao"
                            3 => "N&#46; Xiong"
                            4 => "A&#46; Abdelmaksoud"
                            5 => "H&#46; Wang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.wneu.2017.10.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "World Neurosurg"
                        "fecha" => "2018"
                        "volumen" => "109"
                        "paginaInicial" => "e531"
                        "paginaFinal" => "538"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29038085"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effectiveness of Gamma Knife Radiosurgery in improving psychophysical performance and patient&#8217;s quality of life in idiopathic trigeminal neuralgia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Gagliardi"
                            1 => "A&#46; Spina"
                            2 => "M&#46; Bailo"
                            3 => "N&#46; Boari"
                            4 => "A&#46; Cavalli"
                            5 => "A&#46; Franzin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.wneu.2017.11.096"
                      "Revista" => array:6 [
                        "tituloSerie" => "World Neurosurg"
                        "fecha" => "2018"
                        "volumen" => "110"
                        "paginaInicial" => "e776"
                        "paginaFinal" => "785"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29174233"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Radiosurgical treatment of trigeminal neuralgia&#58; evaluating quality of life and treatment outcomes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;H&#46; Petit"
                            1 => "J&#46;M&#46; Herman"
                            2 => "S&#46; Nagda"
                            3 => "S&#46;J&#46; DiBiase"
                            4 => "L&#46;S&#46; Chin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Radiat Oncol Biol Phys"
                        "fecha" => "2003"
                        "volumen" => "56"
                        "paginaInicial" => "1147"
                        "paginaFinal" => "1153"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/25298496/0000003500000005/v2_202409060916/S2529849624000200/v2_202409060916/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "65581"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Clinical research"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/25298496/0000003500000005/v2_202409060916/S2529849624000200/v2_202409060916/en/main.pdf?idApp=UINPBA00004B&text.app=https://revistaneurocirugia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529849624000200?idApp=UINPBA00004B"
]

Indexed in:

Follow us:

Subscribe:

Article

Indexed in:

Follow us:

Subscribe:

Article

Subscribe to our newsletter