McNatt Sean A, Yu Cheng, Giannotta Steven L, Zee Chi-Shing, Apuzzo Michael L J, Petrovich Zbigniew
Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA.
Neurosurgery. 2005 Jun;56(6):1295-301; discussion 1301-3. doi: 10.1227/01.neu.0000160073.02800.c7.
The purpose of this study was to assess outcomes in patients treated with gamma knife radiosurgery for trigeminal neuralgia.
From 1997 to 2003, a total of 49 patients with trigeminal neuralgia underwent gamma knife radiosurgery. The trigeminal root entry zone immediately adjacent to the pons was targeted by use of a 4-mm collimator to deliver 40 Gy to the 50% isodose line (maximum dose, 80 Gy). Special care was taken to limit radiation dose to the adjacent pons to 12 Gy. Of the 49 study patients, all had undergone previous medical therapy, 8 (16%) had undergone microvascular decompression, 8 (16%) had undergone percutaneous rhizotomy, 2 (4%) had undergone linear accelerator-based radiosurgery, and 5 (10%) presented with multiple sclerosis. The median duration of symptoms was 6 years. There were 29 female patients (59%) and 20 male patients (41%). Facial pain outcomes were assessed by use of the Barrow Neurological Institute pain score. Other outcomes assessed included recurrence of symptoms and treatment toxicity. The median follow-up period was 49 months.
At last evaluation, a total of 27 patients (61%) with idiopathic trigeminal neuralgia reported pain relief (scores of IIIb or less). This included 14 patients (32%) who reported complete pain relief when not receiving medications. Significant recurrence of pain after an initial interval of relief was reported by 10 patients (23%). Mean time to pain recurrence was 9.6 months (range, 2-36 mo). Mild to moderate facial numbness was experienced by 13 patients (29%), whereas 8 (18%) reported mild dysesthesias.
Gamma knife radiosurgery established durable pain relief in 61% of patients with medically refractory idiopathic trigeminal neuralgia. A longer follow-up period is necessary to fully assess the incidence of late complications and recurrences.
本研究旨在评估接受伽玛刀放射外科治疗的三叉神经痛患者的治疗效果。
1997年至2003年，共有49例三叉神经痛患者接受了伽玛刀放射外科治疗。使用4毫米准直器将紧邻脑桥的三叉神经根入区作为靶点，向50%等剂量线给予40 Gy（最大剂量80 Gy）。特别注意将相邻脑桥的辐射剂量限制在12 Gy以内。49例研究患者均曾接受过药物治疗，其中8例（16%）接受过微血管减压术，8例（16%）接受过经皮神经根切断术，2例（4%）接受过基于直线加速器的放射外科治疗，5例（10%）患有多发性硬化症。症状的中位持续时间为6年。女性患者29例（59%），男性患者20例（41%）。采用巴罗神经学研究所疼痛评分评估面部疼痛效果。评估的其他结果包括症状复发和治疗毒性。中位随访期为49个月。
在最后一次评估时，共有27例（61%）特发性三叉神经痛患者报告疼痛缓解（评分在IIIb或更低）。这包括14例（32%）在未服用药物时报告完全疼痛缓解的患者。10例（23%）患者在最初缓解期后报告疼痛明显复发。疼痛复发的平均时间为9.6个月（范围为2至36个月）。13例（29%）患者经历了轻度至中度面部麻木，而8例（18%）报告有轻度感觉异常。
伽玛刀放射外科使61%药物难治性特发性三叉神经痛患者获得了持久的疼痛缓解。需要更长的随访期来全面评估晚期并发症和复发的发生率。
