Department of Radiology, Winthrop-University Hospital, Mineola, New York 11501, USA.
J Neurointerv Surg. 2013 Jan 1;5(1):81-5. doi: 10.1136/neurintsurg-2011-010125. Epub 2012 Jan 25.
To assess the short term efficacy of Cyberknife stereotactic radiosurgical treatment of trigeminal neuralgia (TN).
17 consecutive patients with medically or surgically refractory unilateral TN were treated with Cyberknife radiosurgery. Using superimposed CT cisternogram and MR images, the target segment of the trigeminal nerve was consistently defined as a 6 mm length of nerve approximately 2-3 mm distal to the dorsal root entry zone of the brainstem. A radiosurgical rhizotomy was performed with the Cyberknife utilizing a single collimator to deliver an average maximum dose of 73.06 Gy (range 72.91-73.73) to the target.
Follow-up data were available for 16 of the 17 patients post-treatment (range 1-27 months, average 11.8 months). Overall, 14 of 16 (88%) patients responded favorably with either partial or complete relief of symptomatology. 11 of these patients were successfully free of all pain at some point in their post-treatment course, with seven patients pain free to the last follow-up visit (average 5.0 months, range 1-13 months). Symptoms recurred in four patients, taking place at 3, 7.75, 9 and 18 months after Cyberknife therapy. Only two patients reported side effects. One patient developed a bothersome feathery dysesthesia while the second patient reported a non-bothersome mild jaw hypoesthesia. There were no substantial complications related to stereotactic radiosurgery.
Cyberknife radiosurgery is a viable treatment alternative in patients with TN with competitive efficacy demonstrated in our group of patients while minimizing adverse effects.
评估 Cyberknife 立体定向放射外科治疗三叉神经痛（TN）的短期疗效。
对 17 例药物或手术难治性单侧 TN 患者采用 Cyberknife 放射外科治疗。使用叠加 CT 脑池造影和 MR 图像，将三叉神经根的靶段一致定义为距脑干背根入口区 2-3mm 处约 6mm 长的神经。利用 Cyberknife 单准直器进行放射外科神经根切断术，将平均最大剂量 73.06Gy（范围 72.91-73.73）施于靶区。
17 例患者中有 16 例（16/17，94%）在治疗后获得随访数据（范围 1-27 个月，平均 11.8 个月）。总体而言，16 例患者中有 14 例（14/16，88%）的治疗效果良好，症状得到部分或完全缓解。其中 11 例患者在治疗过程中的某个时间点完全没有疼痛，7 例患者到最后一次随访时无疼痛（平均 5.0 个月，范围 1-13 个月）。4 例患者出现症状复发，分别发生在 Cyberknife 治疗后 3、7.75、9 和 18 个月。只有 2 例患者报告了副作用。1 例患者出现烦人的羽毛样感觉异常，另 1 例患者报告轻微的非烦人的下颌感觉减退。无与立体定向放射外科相关的严重并发症。
Cyberknife 放射外科治疗三叉神经痛是一种可行的治疗选择，在我们的患者群体中显示出竞争性疗效，同时最大限度地减少不良反应。
