Takanashi Masami, Fukuoka Seiji, Ozaki Yoshimaru, Satou Kenichi, Oikawa Mitsuteru, Nakamura Hirohiko
Department of Neurological Surgery, Nakamura Memorial Hospital.
No Shinkei Geka. 2013 Dec;41(12):1065-74.
A multi-institutional study was conducted to evaluate the results of gamma knife radiosurgery (GKRS) for the treatment of trigeminal neuralgia. Eleven hundred and thirty-five patients at 39 centers were analyzed. Three hundred and sixty-nine patients had undergone percutaneous nerve block and 173 patients had undergone microvascular decompression (MVD) prior to GKRS. GKRS was performed for 69.4% of patients targeted at the nerve root entry zone (REZ) and for 20.4% of patients targeted at the retrogasserian region (RGR). The target dose of the GKRS used in the current study varied from 70 to 90 Gy (mean: 77.8Gy). The median follow-up period after GKRS was 21.1 months (range 1 to 125 months). Six hundred and eighty-nine patients (66%) responded with excellent or good control (pain free), 157 (15%) obtained fair control (more than 50% relief), and 192 (19%) experienced treatment failure. After 3 years, 64% of cases were pain free and 80% had more than 50% pain relief. After 4 years, 37 patients underwent additional GKRS, 36 MVD and 36 percutaneous nerve block. Tolerable hypoesthesia or paresthesia occurred in 129 patients (11%), whereas bothersome symptoms developed in 8 patients (1%). But no patient developed deafferentation pain. Nine patients (1%) complained of dry eye, but no other abnormalities of the cornea and conjunctiva were found on ophthalmological examination. Higher maximum radiosurgical dose was associated with a significantly greater factor of complete pain relief (p=0.0101). GKRS is a safe and effective alternative treatment for trigeminal neuralgia, and is a minimally invasive treatment. In addition it provided benefit to a patient population unwilling or unable to undergo more invasive surgical approaches.
一项多机构研究旨在评估伽玛刀放射外科手术（GKRS）治疗三叉神经痛的效果。对39个中心的1135例患者进行了分析。694例患者在接受GKRS之前曾接受过经皮神经阻滞，173例患者曾接受过微血管减压术（MVD）。69.4%的患者在神经根入区（REZ）接受GKRS治疗，20.4%的患者在半月神经节后部区域（RGR）接受治疗。本研究中使用的GKRS靶剂量为70至90 Gy（平均：77.8 Gy）。GKRS后的中位随访期为21.1个月（范围1至125个月）。689例患者（66%）获得了优或良的疼痛控制（无痛），157例（15%）获得了尚可的疼痛控制（疼痛缓解超过50%），192例（19%）治疗失败。3年后，64%的病例无痛，80%的病例疼痛缓解超过50%。4年后，37例患者接受了再次GKRS，36例接受了MVD，36例接受了经皮神经阻滞。129例患者（11%）出现了可耐受的感觉减退或感觉异常，而8例患者（1%）出现了令人困扰的症状。但没有患者出现去传入性疼痛。9例患者（1%）抱怨有干眼，但眼科检查未发现角膜和结膜的其他异常。更高的最大放射外科剂量与完全疼痛缓解的显著更大因素相关（p = 0.0101）。GKRS是三叉神经痛的一种安全有效的替代治疗方法，是一种微创治疗。此外，它为不愿意或无法接受更具侵入性手术方法的患者群体带来了益处。
