Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
J Neurosurg. 2016 Oct;125(4):838-844. doi: 10.3171/2015.7.JNS15451. Epub 2016 Jan 22.
OBJECTIVE Gamma Knife surgery (GKS) represents an alternative treatment for patients with tumor-related trigeminal neuralgia (TRTN). However, in previous studies, the primary GKS target was limited to mass lesions. The authors evaluated whether GKS could target both the tumor and the trigeminal root exit zone (REZ) in a single session while providing durable pain relief and minimizing radiation dose-related complications for TRTN patients. METHODS The authors' institutional review board approved the retrospective analysis of data from 15 consecutive patients (6 men and 9 women, median age 67 years, range 45-79 years) with TRTN who had undergone GKS. In all cases, the radiation was delivered in a single session targeting both the tumor and trigeminal REZ. The authors assessed the clinical outcomes, including the extent of pain relief, durability of the treatment response, and complications. Radiation doses to organs at risk (OARs), including the brainstem and the cranial nerve VII-VIII complex, were analyzed as doses received by 2% or 50% of the tissue volume and the tissue volume covered by a dose of 12 Gy (V). RESULTS The median length of clinical follow-up was 38 months (range 12-78 months). Pain relief with GKS was initially achieved in 14 patients (93.3%) and at the last follow-up in 13 patients (86.7%). The actuarial recurrence-free survival rates were 93%, 83%, and 69% at 1, 3, and 5 years after GKS, respectively. Persistent facial numbness was observed in 3 patients (20.0%). There were no complications such as facial weakness, altered taste function, hearing impairment, and balance difficulties indicating impaired function of the cranial nerve VII-VIII complex. The V in the brainstem was less than or equal to 0.24 cm in all patients. There were no significant differences in any OAR values in the brainstem between patients with and without facial numbness after GKS. CONCLUSIONS The strategy of performing GKS for both tumor and trigeminal REZ in a single session is a safe and effective radiosurgical approach that achieves durable pain control for TRTN patients.
伽玛刀手术（GKS）是治疗肿瘤相关三叉神经痛（TRTN）患者的一种替代治疗方法。然而，在以前的研究中，GKS 的主要治疗靶点仅限于肿块病变。作者评估了单次 GKS 是否可以同时针对肿瘤和三叉神经根出口区（REZ），为 TRTN 患者提供持久的疼痛缓解，并最大程度地减少与辐射剂量相关的并发症。
作者所在机构的审查委员会批准了对 15 例连续接受 GKS 治疗的 TRTN 患者（6 名男性和 9 名女性，中位年龄 67 岁，范围 45-79 岁）数据的回顾性分析。在所有情况下，辐射均在单次治疗中同时针对肿瘤和三叉神经 REZ 进行。作者评估了临床结果，包括疼痛缓解程度、治疗反应的持久性和并发症。分析了危险器官（OAR）的辐射剂量，包括脑干和颅神经 VII-VIII 复合体，分析指标包括组织体积 2%或 50%所接受的剂量（D2 和 D50）和 12 Gy 剂量覆盖的组织体积（V12）。
中位临床随访时间为 38 个月（范围 12-78 个月）。14 例患者（93.3%）在 GKS 初始时获得疼痛缓解，13 例患者（86.7%）在最后一次随访时获得疼痛缓解。GKS 后 1、3 和 5 年的无复发生存率分别为 93%、83%和 69%。3 例患者（20.0%）出现持续性面部麻木。无面部无力、味觉功能改变、听力障碍和平衡困难等并发症，表明颅神经 VII-VIII 复合体功能受损。所有患者脑干的 V 值均小于或等于 0.24 cm。GKS 后有无面部麻木的患者脑干 OAR 值无显著差异。
单次 GKS 同时治疗肿瘤和三叉神经 REZ 是一种安全有效的放射外科方法，可为 TRTN 患者提供持久的疼痛控制。
