Department of Radiation Oncology, Wake Forest University Health Sciences, Winston-Salem, North Carolina, USA.
Neurosurgery. 2012 Mar;70(3):566-72; discussion 572-3. doi: 10.1227/NEU.0b013e3182320d36.
Gamma Knife radiosurgery (GKRS) has been reported to be an effective modality to treat trigeminal neuralgia.
To determine predictive factors for the successful treatment of trigeminal neuralgia with GKRS.
Between 1999 and 2008, 777 GKRS procedures for patients with trigeminal neuralgia were performed at our institution. Evaluable follow-up data were obtained for 448 patients. Median follow-up time was 20.9 months (range, 3-86 months). The mean maximum prescribed dose was 88 Gy (range, 80-97 Gy). Dosimetric variables recorded included dorsal root entry zone dose, pons maximum dose, dose to the petrous dural ridge, and cisternal nerve length.
By 3 months after GKRS, 86% of patients achieved Barrow Neurologic Institute I to III pain scores, with 43% of patients achieving a Barrow Neurologic Institute I pain score. Twenty-six percent of patients reported posttreatment facial numbness; 28% of patients reported a post-GKRS procedure for relapsed pain, and median time to next procedure was 4.4 years. Multivariate analysis revealed that the development of postsurgical numbness (odds ratio [OR], 2.76; P = .006) was the dominant factor predictive of efficacy. Longer cisternal nerve length (OR, 0.85; P = .005), prior radiofrequency ablation (OR, 0.35; P = .028), and diabetes mellitus (OR, 0.38; P = .013) predicted decreased efficacy. The mean dose delivered to the dorsal root entry zone dose in patients who developed facial numbness (57.6 Gy) was more than the mean dose (47.3 Gy) given to patients who did not develop numbness (P = .02).
The development of post-GKRS facial numbness is a dominant factor that predicts for efficacy of GKRS. History of diabetes mellitus or previous radiofrequency ablation may portend worsened outcome.
伽玛刀放射外科（GKRS）已被报道为治疗三叉神经痛的有效方法。
确定 GKRS 治疗三叉神经痛成功的预测因素。
1999 年至 2008 年，我们机构对 777 例三叉神经痛患者进行了 GKRS 治疗。对 448 例患者获得了可评估的随访数据。中位随访时间为 20.9 个月（范围，3-86 个月）。平均最大规定剂量为 88 Gy（范围，80-97 Gy）。记录的剂量学变量包括背根入口区剂量、桥脑最大剂量、岩骨脑膜脊剂量和池状神经长度。
GKRS 后 3 个月，86%的患者达到了巴罗神经病学研究所 I 至 III 级疼痛评分，其中 43%的患者达到了巴罗神经病学研究所 I 级疼痛评分。26%的患者报告治疗后面部麻木；28%的患者报告 GKRS 后复发疼痛，并再次治疗的中位时间为 4.4 年。多变量分析显示，术后麻木的发展（优势比[OR]，2.76；P =.006）是预测疗效的主要因素。池状神经长度较长（OR，0.85；P =.005）、先前射频消融（OR，0.35；P =.028）和糖尿病（OR，0.38；P =.013）预测疗效降低。发生面部麻木的患者（57.6 Gy）接受的背根入口区剂量的平均剂量高于未发生麻木的患者（47.3 Gy）（P =.02）。
GKRS 后出现面部麻木是预测 GKRS 疗效的主要因素。糖尿病或先前射频消融的病史可能预示着结果恶化。
