Dhople Anil, Kwok Young, Chin Lawrence, Shepard David, Slawson Robert, Amin Pradip, Regine William
Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Int J Radiat Oncol Biol Phys. 2007 Oct 1;69(2):397-403. doi: 10.1016/j.ijrobp.2007.03.001. Epub 2007 Apr 30.
To assess efficacy and quality of life (QOL) outcomes associated with gamma-knife radiosurgery (GK-RS) in treating atypical trigeminal neuralgia (ATN) compared with classic trigeminal neuralgia (CTN).
Between September 1996 and September 2004, 35 cases of ATN were treated with GK-RS. Patients were categorized into two groups: Group I comprised patients presenting with ATN (57%); Group II consisted of patients presenting with CTN then progressing to ATN (43%). Median prescription dose 75 Gy (range, 70-80 Gy) was delivered to trigeminal nerve root entry zone. Treatment efficacy and QOL improvements were assessed with a standardized questionnaire.
With median follow-up of 29 months (range, 3-74 months), 72% reported excellent/good outcomes, with mean time to relief of 5.8 weeks (range, 0-24 weeks) and mean duration of relief of 62 weeks (range, 1-163 weeks). This rate of pain relief is similar to rate achieved in our previously reported experience treating CTN with GK-RS (p = 0.36). There was a trend toward longer time to relief (p = 0.059), and shorter duration of relief (p = 0.067) in patients with ATN. There was no difference in rate of, time to, or duration of pain relief between Groups I and II. Of the patients with ATN, 88% discontinued or decreased the use of pain medications. Among the patients with sustained pain relief, QOL improved an average of 85%.
This is the largest reported GK-RS experience for the treatment of ATN. Patients with ATN can achieve rates of pain relief similar to those in patients with CTN. Further follow-up is necessary to assess adequately the durability of response.
评估与经典三叉神经痛（CTN）相比，伽玛刀放射外科治疗（GK-RS）治疗非典型三叉神经痛（ATN）的疗效和生活质量（QOL）结果。
1996年9月至2004年9月期间，35例ATN患者接受了GK-RS治疗。患者分为两组：第一组包括患有ATN的患者（57%）；第二组由先患有CTN然后进展为ATN的患者组成（43%）。向三叉神经根入区给予的中位处方剂量为75 Gy（范围70 - 80 Gy）。用标准化问卷评估治疗效果和生活质量改善情况。
中位随访29个月（范围3 - 74个月），72%的患者报告疗效为优/良，平均缓解时间为5.8周（范围0 - 24周），平均缓解持续时间为62周（范围1 - 163周）。这种疼痛缓解率与我们先前报道的用GK-RS治疗CTN的经验所达到的缓解率相似（p = 0.36）。ATN患者的缓解时间有延长趋势（p = 0.059），缓解持续时间有缩短趋势（p = 0.067）。第一组和第二组在疼痛缓解率、缓解时间或缓解持续时间方面没有差异。在ATN患者中，88%停止或减少了止痛药物的使用。在持续疼痛缓解的患者中，生活质量平均提高了85%。
这是报道的最大规模的GK-RS治疗ATN的经验。ATN患者可获得与CTN患者相似的疼痛缓解率。需要进一步随访以充分评估反应的持久性。
