Morbidini-Gaffney Stefania, Chung Chung-Taik, Alpert Tracy Erin, Newman Nancy, Hahn Seung Shin, Shah Hemangini, Mitchell Lisa, Bassano Daniel, Darbar Aneela, Bajwa Saeed Ahmed, Hodge Charles
Department of Radiation Oncology, State University of New York Upstate Medical University, Syracuse, New York 13210, USA.
J Neurosurg. 2006 Dec;105 Suppl:107-11. doi: 10.3171/sup.2006.105.7.107.
The purpose of this study was to assess the efficacy of Gamma Knife surgery (GKS) in treating patients with trigeminal neuralgia (TN). Preliminary results of this study were previously reported. The updated results are reported in this paper.
Ninety seven patients with TN refractory to medical or surgical management underwent GKS between September 1998 and October 2005. Fifteen patients had multiple sclerosis (MS). The radiation dose was escalated from 70 to 99 Gy. The Barrow Neurological Institute Pain Scale (BNIPS) was used to assess pain before and after GKS. Eighty-four patients were available for evaluation with a mean follow up of 8.9 months. The overall response and complete response rates were 70.2% and 36.9%, respectively. At 12 months, there was a greater improvement in BNIPS scores for patients who were treated with two isocenters compared with those treated with a single isocenter. The mean percentage of pain decrease was 56.26% compared with 11.53% (p < 0.001). Patients treated with two isocenters rather than one and patients receiving greater than 85 Gy compared with lower doses had a longer duration of response. Only nine patients (11%) had mild numbness attributable to the GKS. Five of the nine patients experienced complete resolution of facial numbness on follow up. Patients with MS have a shorter duration of response compared with those without MS (p = 0.35).
These updated results show that GKS continues to be an effective therapy for TN. It appears there is an enhanced response with doses 85 Gy or more and with two isocenters without increased complications.
本研究旨在评估伽玛刀手术（GKS）治疗三叉神经痛（TN）患者的疗效。本研究的初步结果此前已报道。本文报告更新后的结果。
1998年9月至2005年10月期间，97例药物或手术治疗无效的TN患者接受了GKS治疗。15例患者患有多发性硬化症（MS）。放射剂量从70 Gy增加到99 Gy。采用巴罗神经学研究所疼痛量表（BNIPS）评估GKS治疗前后的疼痛情况。84例患者可供评估，平均随访8.9个月。总体缓解率和完全缓解率分别为70.2%和36.9%。在12个月时，与单等中心治疗的患者相比，双等中心治疗的患者BNIPS评分改善更大。疼痛减轻的平均百分比为56.26%，而单等中心治疗患者为11.53%（p<0.001）。双等中心治疗的患者与单等中心治疗的患者相比，以及接受大于85 Gy剂量与较低剂量的患者相比，缓解持续时间更长。只有9例患者（11%）因GKS出现轻度麻木。9例患者中有５例在随访时面部麻木完全消失。与无MS的患者相比，MS患者的缓解持续时间较短（p = 0.35）。
这些更新后的结果表明，GKS仍然是治疗TN的有效方法。似乎85 Gy或更高剂量以及双等中心治疗可增强疗效，且不增加并发症。
