Lucas John T, Huang Andrew J, Bourland J Daniel, Laxton Adrian W, Tatter Stephen B, Chan Michael D
Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA.
Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA.
J Radiosurg SBRT. 2016;4(2):117-123.
BACKGROUND/AIMS: To evaluate clinical and dosimetric predictors of trigeminal nerve dysfunction (TND) following stereotactic radiosurgery (SRS) for Trigeminal Neuralgia (TN).
We retrospectively reviewed our cohort of 446 patients with TN who underwent SRS between 1999-2008. Median follow-up was 25.1 and 17.4 months (mo) in those with and without TND respectively. Dosimetric and anatomic measurements and clinical features including Burchiel subtype, pain quality, prior procedures, comorbidities, and medications were evaluated for their influence on the TND using univariate and multivariate logistic regression modeling.
TND was observed in 44.6% of patients and was similar across facial pain types. Those with TND had prolonged time to pain relapse [(TND, 68.48 mo) vs. (No TND, 29.37 mo)]. Multivariate analysis identified sharp pain at diagnosis (OR 0.594; 95%CI 0.38-0.91), and dorsal root entry zone (DREZ) maximum dose (OR 1.022; 95%CI 1.00-1.04) as predictors of TND.
The presence of sharp pain and increasing DREZ maximum dose were independently associated with TND. Patients with atypical facial pain were at lower risk of TND with increasing dose relative to Type 1 and Type 2 TN.
背景/目的：评估立体定向放射外科治疗（SRS）三叉神经痛（TN）后三叉神经功能障碍（TND）的临床和剂量学预测因素。
我们回顾性分析了1999年至2008年间接受SRS治疗的446例TN患者队列。有和没有TND的患者中位随访时间分别为25.1个月和17.4个月。使用单因素和多因素逻辑回归模型评估剂量学和解剖学测量以及临床特征，包括Burchiel亚型、疼痛性质、既往治疗、合并症和药物治疗对TND的影响。
44.6%的患者出现TND，且在不同面部疼痛类型中相似。出现TND的患者疼痛复发时间延长[（TND组，68.48个月） vs. （无TND组，29.37个月）]。多因素分析确定诊断时的锐痛（OR 0.594；95%CI 0.38 - 0.91）和背根入髓区（DREZ）最大剂量（OR 1.022；95%CI 1.00 - 1.04）为TND的预测因素。
锐痛的存在和DREZ最大剂量增加与TND独立相关。与1型和2型TN相比，非典型面部疼痛患者随着剂量增加出现TND的风险较低。
