Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.
J Neurosurg. 2012 Dec;117 Suppl:175-80. doi: 10.3171/2012.6.GKS12987.
Among patients with multiple sclerosis (MS) there is a high incidence of trigeminal neuralgia (TN), and outcomes after treatment seem inferior to those in patients suffering from idiopathic TN. The goal of this study was to evaluate clinical outcomes in patients with MS-related TN after Gamma Knife surgery (GKS) and compare them with those obtained using percutaneous retrogasserian glycerol rhizotomy (PRGR).
The authors retrospectively reviewed the charts of 45 patients with MS-related TN. The first procedure undertaken was GKS in 27 patients and PRGR in 18 patients. Pain had been present for a median of 60 months (range 12-276 months) in patients who underwent GKS and 48 months (range 12-240 months) in patients who underwent PRGR. The following outcome measures were assessed in both groups of patients: pain relief (using the Barrow Neurological Institute [BNI] Pain Scale), procedure-related morbidity, time to pain relief and recurrence, and subsequent procedures that were performed.
The median duration of follow-up was 39 months (range 13-69 months) in the GKS group and 38 months (range 2-75 months) in the PRGR group. Reasonable pain control (BNI Pain Scale Scores I-IIIb) was noted in 22 patients (81.5%) who underwent GKS and in 18 patients (100%) who underwent PRGR. For patients who underwent GKS, the median time to pain relief was 6 months; for those who underwent PRGR, pain relief was immediate. In the GKS group 12 patients required subsequent procedures (3 patients for absence of response and 9 patients for pain recurrence), whereas in the PRGR group 6 patients required subsequent procedures (all for pain recurrence). As of the last follow-up, complete or reasonable pain control was finally achieved in 23 patients (85.2%) in the GKS group and in 16 patients (88.9%) in the PRGR group. The morbidity rate was 22.2% in the GKS group (all due to sensory loss and paresthesia) and 66.7% in the PRGR group (mostly hypalgesia, with 2 patients having corneal reflex loss and 1 patient suffering from meningitis).
Both GKS and PRGR are satisfactory strategies for treating MS-related TN. Gamma Knife surgery has a lower rate of sensory and overall morbidity than PRGR, but requires a delay before pain relief occurs. The authors propose that patients with extreme pain in need of fast relief should undergo PRGR. For other patients, both management strategies can lead to satisfactory pain relief, and the choice should be made based on patient preference and expectations.
多发性硬化症（MS）患者三叉神经痛（TN）发病率较高，且治疗后结局似乎不如特发性 TN 患者。本研究旨在评估 MS 相关 TN 患者伽玛刀手术（GKS）后的临床结局，并与经皮后根甘油醇松解术（PRGR）进行比较。
作者回顾性分析了 45 例 MS 相关 TN 患者的病历。27 例患者首次行 GKS，18 例患者行 PRGR。GKS 组患者疼痛时间中位数为 60 个月（范围 12-276 个月），PRGR 组为 48 个月（范围 12-240 个月）。两组患者均评估以下结局指标：疼痛缓解（采用巴罗神经研究所[BNI]疼痛量表）、与治疗相关的发病率、疼痛缓解和复发时间，以及随后进行的治疗。
GKS 组中位随访时间为 39 个月（范围 13-69 个月），PRGR 组为 38 个月（范围 2-75 个月）。22 例（81.5%）接受 GKS 治疗的患者和 18 例（100%）接受 PRGR 治疗的患者疼痛得到合理控制（BNI 疼痛量表评分 I-IIIb）。GKS 组疼痛缓解的中位时间为 6 个月，PRGR 组为即刻缓解。GKS 组 12 例患者需要后续治疗（3 例无反应，9 例疼痛复发），PRGR 组 6 例患者需要后续治疗（均因疼痛复发）。末次随访时，GKS 组 23 例（85.2%）和 PRGR 组 16 例（88.9%）患者最终获得完全或合理的疼痛控制。GKS 组发病率为 22.2%（均为感觉丧失和感觉异常），PRGR 组为 66.7%（主要为感觉迟钝，2 例患者角膜反射丧失，1 例患者患脑膜炎）。
GKS 和 PRGR 均为治疗 MS 相关 TN 的满意策略。与 PRGR 相比，GKS 手术的感觉和总体发病率较低，但缓解疼痛需要一定时间。作者建议需要快速缓解疼痛的极度疼痛患者行 PRGR。对于其他患者，两种治疗策略都能获得满意的疼痛缓解效果，应根据患者的偏好和期望进行选择。
