Dong Guijiang, Li Quanqing, Sun Jin, Chen E, Lin Xiaoning, Tong Junjiang, Chen Hongjin, Yao Xiang, Wang Hongbo, Tian Xinhua
Department of neurosurgery, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
Medicine (Baltimore). 2024 Dec 20;103(51):e41026. doi: 10.1097/MD.0000000000041026.
The effectiveness of Gamma Knife radiosurgery (GKRS) in treating trigeminal neuralgia (TN) has been demonstrated by a number of previous studies. However, there is a lack of research specifically documenting the initial and long-term outcomes of paroxysmal and persistent pain respectively following GKRS for TN with concomitant continuous pain (CCP). This study retrospectively analyzed pain outcomes and complications in 46 TN patients with CCP and 112 patients without CCP who underwent GKRS as initial surgical intervention at our institution from January 2019 to January 2024. Pain outcomes were classified as excellent (BNI I), good (BNI II-IIIa), and poor (BNI IIIb-V). Demographic and clinical data, pain outcomes, and complications were compared between patients with and without CCP. Subsequently, risk factors for poor outcomes after GKRS were evaluated using univariate and multivariate Cox regression analysis. The initial rate of poor outcomes in TN patients with CCP was similar to that of patients without CCP (15.8% vs 14.4%, P = .878). Following a minimum 6-month follow-up, the rate of poor pain outcomes increased to 37.0% in patients with CCP, compared to 38.4% in those without CCP (P = .968). Notably, the rate of long-term complete pain relief in patients without CCP was significantly higher than in those with CCP (35.7% vs 15.2%, P < .001). Poor response to medication (P < .001) was identified as an independent risk factors for poor outcomes after GKRS. While most TN patients with or without CCP can achieve favorable pain outcomes after GKRS, individuals with CCP were less likely to achieve complete pain relief compared to those without CCP.
先前的多项研究已证实伽玛刀放射外科手术（GKRS）治疗三叉神经痛（TN）的有效性。然而，缺乏专门记录GKRS治疗伴有持续性疼痛（CCP）的TN患者后阵发性疼痛和持续性疼痛的初始及长期结果的研究。本研究回顾性分析了2019年1月至2024年1月在我院接受GKRS作为初始手术干预的46例伴有CCP的TN患者和112例不伴有CCP的患者的疼痛结果及并发症。疼痛结果分为优秀（BNI I级）、良好（BNI II - IIIa级）和差（BNI IIIb - V级）。比较了伴有和不伴有CCP患者的人口统计学和临床数据、疼痛结果及并发症。随后，使用单因素和多因素Cox回归分析评估GKRS后预后不良的危险因素。伴有CCP的TN患者初始预后不良率与不伴有CCP的患者相似（15.8%对14.4%，P = 0.878）。在至少6个月的随访后，伴有CCP的患者疼痛预后不良率增至37.0%，而不伴有CCP的患者为38.4%（P = 0.968）。值得注意的是，不伴有CCP的患者长期完全疼痛缓解率显著高于伴有CCP的患者（35.7%对15.2%，P < 0.001）。药物反应不佳（P < 0.001）被确定为GKRS后预后不良的独立危险因素。虽然大多数伴有或不伴有CCP的TN患者在GKRS后可获得良好的疼痛结果，但与不伴有CCP的患者相比，伴有CCP的患者更难实现完全疼痛缓解。
