Kim Yong Hwy, Kim Dong Gyu, Kim Jin Wook, Kim Young-Hoon, Han Jung Ho, Chung Hyun-Tai, Paek Sun Ha
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea.
Stereotact Funct Neurosurg. 2010;88(3):169-76. doi: 10.1159/000313869. Epub 2010 May 1.
In order to assess the effect of raising gamma knife radiosurgery (GKS) doses from 80 to 85 Gy for the treatment of trigeminal neuralgia (TN), the authors analyzed the outcomes of GKS in each group.
The authors retrospectively collected follow-up data of 104 GKS procedures conducted for TN. Doses of 80 and 85 Gy were prescribed for 60 and 44 patients, respectively. The target was 2-4 mm anterior to the junction of the trigeminal nerve and pons. Outcomes were quantified based on facial pain levels and classified using the Barrow Neurological Institute scale.
Actuarial rates of a favorable pain control outcome at 1 and 3 years after GKS were 75.0 and 61.2% for 80 Gy and 65.9 and 60.3% for 85 Gy. Post-GKS facial sensory loss developed in 20.6%. There was no statistically significant difference in pain control rate between the two groups. Time to maximal pain relief was shorter in the 85-Gy group. Protracted morbidity before GKS was a favorable prognostic factor of pain control in a multivariate analysis.
According to our finding that 85 Gy brought more rapid clinical improvement without causing more complications, 85 Gy seems to be preferable to 80 Gy, but prospective randomized trials are mandatory to get a more definite conclusion on the optimal dose for GKS of TN.
为评估将伽玛刀放射外科手术（GKS）治疗三叉神经痛（TN）的剂量从80 Gy提高到85 Gy的效果，作者分析了每组GKS的治疗结果。
作者回顾性收集了104例因TN接受GKS手术的随访数据。分别对60例和44例患者给予80 Gy和85 Gy的剂量。靶点位于三叉神经与脑桥交界处前方2 - 4 mm处。根据面部疼痛程度对结果进行量化，并使用巴罗神经学研究所量表进行分类。
GKS术后1年和3年疼痛控制良好的精算率，80 Gy组分别为75.0%和61.2%，85 Gy组分别为65.9%和60.3%。GKS术后面部感觉丧失发生率为20.6%。两组间疼痛控制率无统计学显著差异。85 Gy组达到最大疼痛缓解的时间更短。在多因素分析中，GKS术前的长期发病率是疼痛控制的有利预后因素。
根据我们的研究发现，85 Gy能带来更快的临床改善且不会引发更多并发症，85 Gy似乎比80 Gy更可取，但必须进行前瞻性随机试验，以就TN的GKS最佳剂量得出更明确的结论。
