Shaya Mark, Jawahar Ajay, Caldito Gloria, Sin Anthony, Willis Brian K, Nanda Anil
Department of Neurosurgery, Louisiana State University Health Sciences Center in Shreveport, 71130, USA.
Surg Neurol. 2004 Jun;61(6):529-34; discussion 534-5. doi: 10.1016/j.surneu.2003.11.027.
Trigeminal neuralgia (TN) is a painful condition of controversial origin; however, vascular compression of the root entry zone of the trigeminal nerve is thought to be responsible in some cases. Recently, stereotactic radiosurgery has been established as an alternative treatment for medically intractable TN.
Forty patients with medically refractory TN underwent gamma knife surgery for pain control at our institution. Dose planning was based on high-resolution, contrast-enhanced, axial, volume acquisition magnetic resonance images. Images were reviewed to detect vascular compression of the trigeminal nerve at the root entry zone by an observer blinded to the affected side and the outcome. Another observer, blinded to radiologic findings, conducted the patient follow-up. Results were classified as excellent and good (favorable outcomes) and failure (unfavorable) based upon the intensity of pain, frequency of episodes, pain medications, and need for additional interventions after radiosurgery.
Pain was left-sided in 22 patients and right-sided in 18 patients. Vascular compression of the affected nerve at the root entry zone was demonstrable in 14 patients. Prescription dose ranged from 70 to 90 Gy. At a median follow-up of 14 months (range, 3-31 months), 16 patients (40%) had excellent pain control, 12 (30%) had good control, while 12 (30%) had failed treatment. The Kaplan-Meier actuarial pain control rate at 15 months was 82.25 +/- 0.8% (95%CI). Magnetic resonance detectable vascular compression did not affect the outcome (p = 0.6). Increasing marginal dose (> or =40Gy) was a significant predictor of favorable outcome (p = 0.015).
gamma knife surgery is an effective and safe treatment for TN. In our study, we found that vascular compression of the nerve at the root entry zone was not a predictor of the outcome of gamma surgery for TN. The outcome improves with marginal prescription dose of 80 Gy or higher.
三叉神经痛（TN）是一种病因存在争议的疼痛性疾病；然而，在某些情况下，三叉神经根部进入区的血管压迫被认为是其病因。最近，立体定向放射外科已成为药物治疗无效的TN的一种替代治疗方法。
40例药物治疗难治性TN患者在我院接受伽玛刀手术以控制疼痛。剂量规划基于高分辨率、增强对比的轴向容积采集磁共振图像。由一名对患侧和结果不知情的观察者对图像进行检查，以检测三叉神经根部进入区的血管压迫情况。另一名对放射学结果不知情的观察者对患者进行随访。根据疼痛强度、发作频率、止痛药物使用情况以及放射外科手术后是否需要额外干预，将结果分为优和良（良好结果）以及失败（不良结果）。
22例患者疼痛位于左侧，18例位于右侧。14例患者在根部进入区可见患侧神经的血管压迫。处方剂量范围为70至90 Gy。中位随访时间为14个月（范围3至31个月），16例患者（40%）疼痛得到极佳控制，12例（30%）控制良好，12例（30%）治疗失败。15个月时的Kaplan-Meier精算疼痛控制率为82.25±0.8%（95%可信区间）。磁共振可检测到的血管压迫不影响治疗结果（p = 0.6）。增加边缘剂量（≥40 Gy）是良好结果的显著预测因素（p = 0.015）。
伽玛刀手术是治疗TN的一种有效且安全的方法。在我们的研究中，我们发现神经根部进入区的血管压迫不是TN伽玛刀手术结果的预测因素。边缘处方剂量达到80 Gy或更高时结果改善。
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