Cheng Jian, Liu Wenke, Hui Xuhui, Lei Ding, Zhang Heng
Department of Neurosurgery West China Hospital, Sichuan University, Chengdu, China.
Department of Neurosurgery West China Hospital, Sichuan University, Chengdu, China.
Clin Neurol Neurosurg. 2017 Oct;161:88-92. doi: 10.1016/j.clineuro.2017.08.017. Epub 2017 Aug 30.
Though it is usually successful, failure or delayed pain recurrence may occur after gamma knife surgery (GKS) in patients with trigeminal neuralgia (TN), and additional intervention may be required. This study aimed to investigate whether the safety and efficacy of microvascular decompression (MVD) were influenced by prior GKS.
The authors retrospectively evaluated 36 consecutive TN patients who underwent MVD after failed GKS from January 2012 to June 2013. The clinical features, operative findings and surgical outcomes were reviewed and statistically analyzed, and the operation results were further compared with a cohort of 60 patients with no prior GKS.
At surgery, atrophy of the trigeminal nerve was observed in 13 patients (36.1%), arachnoid thickening in 6 patients (16.7%), adhesions between vessels and the trigeminal nerve in 8 patients (22.2%), and atherosclerotic plaque in the offending vessels in 3 patients (8.3%). The complete pain relief rates were 83.3% immediately after MVD and 72.2% at last follow-up, which showed no statistical difference when compared with patients without GKS. New or worsened facial numbness occurred in 7 patients (19.4%), which was significantly higher than those without GKS (p=0.02). Univariate analysis suggested that a positive pain response to the prior GKS correlated with better long-term outcome (p=0.015), and the existence of arachnoid adhesions correlated with higher risk of facial numbness (p=0.03).
MVD remains an appropriate and effective alternative therapy for patients with failed GKS, with no added technical difficulty. However, the risk of facial numbness seems to be higher than those with MVD alone.
虽然伽玛刀手术（GKS）治疗三叉神经痛（TN）通常是成功的，但仍可能出现失败或疼痛延迟复发的情况，可能需要进一步干预。本研究旨在调查先前的GKS是否会影响微血管减压术（MVD）的安全性和有效性。
作者回顾性评估了2012年1月至2013年6月期间36例GKS治疗失败后接受MVD的连续性TN患者。对其临床特征、手术发现和手术结果进行回顾并统计分析，并将手术结果与60例未接受过GKS的患者队列进行进一步比较。
手术时，13例患者（36.1%）观察到三叉神经萎缩，6例患者（16.7%）观察到蛛网膜增厚，8例患者（22.2%）观察到血管与三叉神经之间存在粘连，3例患者（8.3%）观察到责任血管存在动脉粥样硬化斑块。MVD术后即刻完全缓解率为83.3%，末次随访时为72.2%，与未接受GKS的患者相比无统计学差异。7例患者（19.4%）出现新的或加重的面部麻木，显著高于未接受GKS的患者（p=0.02）。单因素分析表明，先前GKS的阳性疼痛反应与更好的长期预后相关（p=0.015），蛛网膜粘连的存在与面部麻木的高风险相关（p=0.03）。
对于GKS治疗失败的患者，MVD仍然是一种合适且有效的替代治疗方法，且不增加技术难度。然而，面部麻木的风险似乎高于单纯接受MVD的患者。
