Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea.
Department of Neurosurgery, Severance Hospital, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
Neurosurg Rev. 2020 Dec;43(6):1631-1640. doi: 10.1007/s10143-020-01346-8. Epub 2020 Jul 8.
Trigeminal neuralgia (TN) is an excruciating pain that can occur with petroclival meningiomas (PCMs). Gamma knife radiosurgery (GKRS) is an appealing option for small PCMs, but the role of microsurgery (MS) compared to GKRS is not well defined for small PCMs with regard to TN relief. From January 2009 to September 2019, 70 consecutive patients were treated by GKRS or MS for newly diagnosed, small (< 3.5 cm) PCMs with TN. GKRS or MS were performed for 35 patients each. The surgical outcome and TN control according to Barrow Neurological Institute (BNI) score were retrospectively analyzed and compared between GKRS and MS. The predominant origin of PCMs was upper clival (49%) with trigeminal nerve compression at the medial dorsal root entry zone. Tumor control rates were equally 94% with GKRS or MS for a mean tumor size and volume of 2.3 cm and 5.3 cm, respectively. The preoperative BNI scores were mostly II (40%) and IV (37%) with GKRS and MS, respectively. TN relief without medications (BNI scores I and II) was achieved in 13 of 35 patients (37%) with GKRS and 32 of 35 patients (91%) with MS during a mean follow-up of 50.5 months. The most common complications after GKRS and MS were dysesthesia (23%) and diplopia (9%), respectively. MS could be more effective than GKRS in providing prompt, medication-free pain relief from TN for small PCMs. The risks of MS have to be considered carefully in experienced hands, especially for small PCMs.
三叉神经痛（TN）是一种剧痛，可发生在岩斜脑膜瘤（PCM）中。对于小的 PCM，伽玛刀放射外科（GKRS）是一种有吸引力的选择，但对于有 TN 缓解的小 PCM，与 GKRS 相比，显微镜手术（MS）的作用尚未明确界定。从 2009 年 1 月至 2019 年 9 月，70 例新诊断的小（<3.5cm）PCM 伴 TN 的患者连续接受 GKRS 或 MS 治疗。GKRS 或 MS 分别治疗 35 例患者。回顾性分析并比较了 GKRS 和 MS 治疗后的手术结果和 TN 控制情况，采用巴罗神经研究所（BNI）评分进行评估。PCM 的主要起源是上斜坡（49%），三叉神经在背根入区内侧受压。GKRS 和 MS 的肿瘤控制率分别为 94%，肿瘤平均大小和体积分别为 2.3cm 和 5.3cm。术前 BNI 评分在 GKRS 和 MS 中分别为 40%和 37%，主要为 II 级（40%）和 IV 级（37%）。GKRS 组 35 例中有 13 例（37%），MS 组 35 例中有 32 例（91%）在平均 50.5 个月的随访中无需药物即可缓解 TN（BNI 评分 I 和 II）。GKRS 和 MS 后最常见的并发症分别是感觉异常（23%）和复视（9%）。MS 比 GKRS 更能有效地为小 PCM 提供快速、无需药物的 TN 疼痛缓解。在有经验的手中，MS 的风险必须仔细考虑，特别是对于小 PCM。
