三叉神经痛伽玛刀放射外科治疗后三叉神经的累积剂量与疼痛结局

Trigeminal nerve integrated dose and pain outcome after gamma knife radiosurgery for trigeminal neuralgia.

作者信息

Alahmadi Hussein, Zadeh Gelareh, Laperriere Norman, Vachhrajani Shobhan, Mazloom Nura, Gentili Fred, Hodaie Mojgan

机构信息

Division of Neurosurgery, Toronto Western Hospital, 4th floor, WW, 399 Bathurst St., Toronto, Ontario, M5T 2S8, Canada.

Department of Radiation Oncology, University of Toronto, 150 College St., Rm. 106, Toronto, Ontario, M5S 3S2, Canada.

出版信息

J Radiosurg SBRT. 2012;1(4):295-301.

PMID:29296330

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5658864/

Abstract

BACKGROUND

Gamma knife radiosurgery (GKRS) is an established treatment for trigeminal neuralgia. Identifying factors that influence outcome will help improve patients' results.

METHODS

We conducted a retrospective review of all patients treated with GKRS for trigeminal neuralgia at our institution from 2005 to 2010. Patients' clinical features and treatment details were reviewed. Analysis was performed to identify predictors of response and recurrence.

RESULTS

A hundred and forty five patients were treated. Mean follow up period was 24 months. At last follow up, 48 patients (33%) were pain free with no medications, and 48 patients (33%) were pain free maintained on medications. Twenty-eight patients (19%) had pain after the treatment but had significant reduction in their pain severity. Twenty-one patients (15%) did not have any significant pain reduction. Forty-four patients (30%) developed facial numbness. Recurrence occurred in 51 patients (35%). Post-treatment numbness was a predictor of good treatment response (OR 2.720, CI 1.193-6.200, p 0.0173). Higher integrated dose was a predictor of poor pain response to radiosurgery (OR 0.729, CI 0.566-0.940, p 0.0146). At an integrated dose value of 5.3 mJ or less, there was more than 50% chance of pain free outcome. Longer pain duration prior to treatment was the only independent predictor of increased recurrence risk (HR 1.038, 95%CI 1.001-1.075; p=0.0412).

CONCLUSIONS

Radiosurgery is an effective treatment modality for trigeminal neuralgia. Post treatment numbness is associated with good treatment response and higher integrated dose predicts poor outcome after radiosurgery for trigeminal neuralgia.

摘要

背景

伽玛刀放射外科手术（GKRS）是治疗三叉神经痛的一种既定方法。识别影响治疗结果的因素将有助于改善患者的治疗效果。

方法

我们对2005年至2010年在我院接受GKRS治疗三叉神经痛的所有患者进行了回顾性研究。回顾了患者的临床特征和治疗细节。进行分析以确定反应和复发的预测因素。

结果

共治疗了145例患者。平均随访期为24个月。在最后一次随访时，48例患者（33%）无需药物治疗即可无痛，48例患者（33%）通过药物维持无痛。28例患者（19%）治疗后仍有疼痛，但疼痛严重程度显著降低。21例患者（15%）疼痛未得到显著减轻。44例患者（30%）出现面部麻木。51例患者（35%）复发。治疗后麻木是良好治疗反应的预测因素（OR 2.720，CI 1.193 - 6.200，p 0.0173）。较高的累积剂量是放射外科手术疼痛反应不佳的预测因素（OR 0.729，CI 0.566 - 0.940，p 0.0146）。当累积剂量值为5.3 mJ或更低时，无痛结局的可能性超过50%。治疗前疼痛持续时间较长是复发风险增加的唯一独立预测因素（HR 1.038，95%CI 1.001 - 1.075；p = 0.0412）。