Zheng L G, Xu D S, Kang C S, Zhang Z Y, Li Y H, Zhang Y P, Liu D, Jia Q
Gamma Knife Center, Department of Neurosurgery, Second Hospital of the Tianjin Medical University, People's Republic of China.
Stereotact Funct Neurosurg. 2001;76(1):29-35. doi: 10.1159/000056492.
Previous papers have reported Gamma Knife radiosurgery to be a safe, effective method for primary trigeminal neuralgia. Since November 1996, we have treated primary trigeminal neuralgia using the Leksell Gamma Knife at the Tianjin Medical University. The present study reports clinical results of Gamma Knife radiosurgery in the treatment of trigeminal neuralgia in 80 cases.
The mean patient age was 67 years (range 32-92), the mean duration of facial pain was 7.6 years (range 1.5-29). The male:female ratio was 31:49. The right side of the face was involved in 45 patients (56.25%) and the left side in 30 cases (37.5%), with bilateral involvement in 5 cases (6.25%). Under local anesthesia, all patients underwent stereotactic MRI to identify the trigeminal nerve. A single isocenter, using a 4-mm collimator, was positioned at the sensory root of the trigeminal nerve entry zone of the pons, 4-6 mm from the brainstem surface, so that no more than the 20% isodose was administered to the brainstem. The maximum dose was between 70 and 90 Gy, with a mean of 75.6 Gy. For bilateral trigeminal neuralgia, two separate matrices were employed, and bilateral Gamma Knife radiosurgery was performed on the same day.
Follow-up ranged from 12 to 43 months (mean 23.7 months). Neurological evaluation indicated excellent response in 42 cases (52.5%), good response in 25 cases (31.25%), effective response in 8 cases (10%), so the total pain control rate was 93.75%. The latency from Gamma Knife surgery to pain relief ranged from 1 to 120 days (mean 22 days). Among the 75 patients 7 with pain control experienced pain recurrence 5-26 months after being completely free from pain. A second Gamma Knife radiosurgery was performed in 7 recurrent cases and 5 patients with treatment failure. A maximal dose ranging from 70 to 80 Gy was given (mean 74.2 Gy). After a mean follow-up of 18 months (8-33 months), 9 patients achieved excellent results, and 2 had good results. The latency interval to pain relief ranged from 1 to 120 days (mean 15 days). Nine patients developed new facial numbness, while no other complication appeared in the remainder of the patients.
Gamma Knife radiosurgery is a safe and effective method in the treatment of trigeminal neuralgia once diagnosis is established.
以往文献报道伽玛刀放射外科手术是治疗原发性三叉神经痛的一种安全、有效的方法。自1996年11月以来，我们在天津医科大学使用Leksell伽玛刀治疗原发性三叉神经痛。本研究报告了伽玛刀放射外科手术治疗80例三叉神经痛的临床结果。
患者平均年龄67岁（范围32 - 92岁），面部疼痛平均持续时间7.6年（范围1.5 - 29年）。男女比例为31:49。45例（56.25%）患者右侧面部受累，30例（37.5%）左侧面部受累，5例（6.25%）双侧受累。在局部麻醉下，所有患者均接受立体定向磁共振成像以识别三叉神经。使用4毫米准直器，将单个等中心置于脑桥三叉神经进入区感觉根处，距脑干表面4 - 6毫米，以使给予脑干的剂量不超过20%等剂量线。最大剂量在70至90 Gy之间，平均为75.6 Gy。对于双侧三叉神经痛，采用两个单独的定位框架，并在同一天进行双侧伽玛刀放射外科手术。
随访时间为12至43个月（平均23.7个月）。神经学评估显示，42例（52.5%）患者反应极佳，25例（31.25%）反应良好，8例（10%）反应有效，因此总疼痛控制率为93.75%。伽玛刀手术后至疼痛缓解的潜伏期为1至120天（平均22天）。在75例疼痛得到控制的患者中，7例在完全无痛后5至26个月出现疼痛复发。对7例复发患者和5例治疗失败患者进行了第二次伽玛刀放射外科手术。给予的最大剂量范围为70至80 Gy（平均74.2 Gy）。平均随访18个月（8 - 33个月）后，9例患者效果极佳，2例效果良好。疼痛缓解的潜伏期为1至120天（平均15天）。9例患者出现新的面部麻木，其余患者未出现其他并发症。
一旦确诊，伽玛刀放射外科手术是治疗三叉神经痛安全有效的方法。
