Jung Hyun Ho, Park Chang Kyu, Jung Na Young, Kim Minsoo, Chang Won Seok, Chang Jin Woo
Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
World Neurosurg. 2017 Aug;104:687-693. doi: 10.1016/j.wneu.2017.05.058. Epub 2017 May 19.
To evaluate pain control and side effects after gamma knife radiosurgery (GKRS) for classical idiopathic trigeminal neuralgia (TN) with or without neurovascular compression (NVC).
This study included 47 patients with type 1 idiopathic TN and Barrow Neurological Institute (BNI) pain class IV or V who were treated with GKRS, with a maximum dose of 85 Gy targeting the root entry zone, as an initial treatment modality between January 2005 and March 2015. A retrospective analysis of NVC status, pain control, side effects, recurrence, and cross-sectional area was conducted.
During follow-up (median, 21.5 months; range, 3-119 months), 36 of the 47 patients (76.6%) demonstrated good outcomes (i.e., improved to below BNI class IIIa). Twenty-two patients did not have NVC (group A) and 25 had NVC (group B). The rate of good outcomes did not differ significantly between the 2 groups (group A, 86.4% [19 of 22] vs. group B, 68% [17 of 25]; P = 0.138). The number of cases in BNI class I or II and the number of recurrences also did not differ significantly between the 2 groups (P = 0.532 and 0.786, respectively). The mean area was 8.64 ± 2.59 mm in nondeviated cases (n = 27) and 2.59 ± 1.68 mm in deviated (n = 10). Side effects were significantly more frequent in deviated cases (80% [8 of 10]) than in nondeviated cases (25.9% [7 of 27]; P = 0.003).
NVC is not a predictive factor for pain control after GKRS for the treatment of idiopathic TN. Side effects may occur more frequently in patients with NVC at the target coordinate when a root entry zone is used, but the subjective symptoms are not always bothersome.
评估伽玛刀放射外科手术（GKRS）治疗伴有或不伴有神经血管压迫（NVC）的经典特发性三叉神经痛（TN）后的疼痛控制情况及副作用。
本研究纳入了47例1型特发性TN且疼痛分级为巴罗神经学研究所（BNI）IV级或V级的患者，他们在2005年1月至2015年3月期间接受了GKRS治疗，以神经根入区为靶点，最大剂量为85 Gy，作为初始治疗方式。对NVC状态、疼痛控制、副作用、复发情况及横截面积进行了回顾性分析。
在随访期间（中位时间为21.5个月；范围为3 - 119个月），47例患者中有36例（76.6%）取得了良好的治疗效果（即改善至BNI IIIa级以下）。22例患者无NVC（A组），25例有NVC（B组）。两组的良好治疗效果发生率无显著差异（A组为86.4%[22例中的19例]，B组为68%[25例中的17例]；P = 0.138）。两组在BNI I级或II级的病例数及复发次数也无显著差异（P分别为0.532和0.786）。未偏移病例（n = 27）的平均面积为8.64 ± 2.59 mm，偏移病例（n = 10）的平均面积为2.59 ± 1.68 mm。偏移病例的副作用发生率（80%[10例中的8例]）显著高于未偏移病例（25.9%[27例中的7例]；P = 0.003）。
NVC不是GKRS治疗特发性TN后疼痛控制的预测因素。当使用神经根入区作为靶点坐标时，NVC患者可能更容易出现副作用，但主观症状并不总是令人困扰。
