Huang Chuan-Fu, Chuang Jim-Chao, Tu Hsien-Tang, Lin Long-Yau
Department of Neurosurgery, Chung-Shan Medical University Hospital, Taichung, Taiwan, Republic of China.
J Neurosurg. 2006 Dec;105 Suppl:99-102. doi: 10.3171/sup.2006.105.7.99.
Repeated Gamma Knife surgery (GKS) for trigeminal neuralgia (TN) is an acceptable method for refractory cases but not well established in terms of dose effect and nerve tolerance. The authors report their experience in 28 patients over 3.5 years of follow up.
Between 1999 and 2004, a total of 28 patients with recurrent or residual TN underwent repeated GKS. The median follow-up periods were 52 and 43 months after the first and repeated procedures, respectively. The entry zone of the trigeminal nerve was targeted using a 4-mm collimator and treated with 40 to 76 Gy as maximal dose. Additive doses ranged between 110 and 152 Gy. The median duration of symptoms was 4.86 years. There were 12 women (46%) and 16 men (54%). At the last evaluation, a total of 19 patients (68%) reported pain relief. Of these patients, 13 were no longer taking pain medications. Significant recurrent or residual pain was noted in nine patients after a median follow up of 12 months (range 6-48 months). New onset of facial numbness was noted in 10 patients. An additive dose above 115 Gy was found to be associated with facial numbness and nonfacial numbness (p = 0.047). No definite additive dose correlation with pain relief was noted (p = 0.23).
Repeated GKS established durable pain relief in a majority of patients, and a higher additive dose (> 115 Gy) tended to cause facial numbness. However, a prospective trial is needed to fully assess the efficacy and late complications of GKS.
对于三叉神经痛（TN）患者，重复进行伽玛刀手术（GKS）是治疗难治性病例的一种可接受方法，但在剂量效应和神经耐受性方面尚未完全明确。作者报告了他们对28例患者进行3.5年随访的经验。
1999年至2004年期间，共有28例复发性或残留性TN患者接受了重复GKS治疗。首次和重复手术后的中位随访期分别为52个月和43个月。使用4毫米准直器靶向三叉神经的进入区域，以40至76 Gy作为最大剂量进行治疗。累积剂量范围为110至152 Gy。症状的中位持续时间为4.86年。其中女性12例（46%），男性16例（54%）。在最后一次评估时，共有19例患者（68%）报告疼痛缓解。其中13例患者不再服用止痛药物。中位随访12个月（范围6 - 48个月）后，9例患者出现明显的复发或残留疼痛。10例患者出现新的面部麻木。发现累积剂量高于115 Gy与面部麻木和非面部麻木相关（p = 0.047）。未发现与疼痛缓解有明确的累积剂量相关性（p = 0.23）。
重复GKS使大多数患者实现了持久的疼痛缓解，较高的累积剂量（> 115 Gy）往往会导致面部麻木。然而，需要进行前瞻性试验来全面评估GKS的疗效和晚期并发症。
