Kondziolka D, Lunsford L D, Flickinger J C, Young R F, Vermeulen S, Duma C M, Jacques D B, Rand R W, Regis J, Peragut J C, Manera L, Epstein M H, Lindquist C
Department of Neurological Surgery, University of Pittsburgh, Pennsylvania, USA.
J Neurosurg. 1996 Jun;84(6):940-5. doi: 10.3171/jns.1996.84.6.0940.
A multiinstitutional study was conducted to evaluate the technique, dose-selection parameters, and results of gamma knife stereotactic radiosurgery in the management of trigeminal neuralgia. Fifty patients at five centers underwent radio-surgery performed with a single 4-mm isocenter targeted at the nerve root entry zone. Thirty-two patients had undergone prior surgery, and the mean number of procedures that had been performed was 2.8 (range 1-7). The target dose of the radiosurgery used in the current study varied from 60 to 90 Gy. The median follow-up period after radiosurgery was 18 months (range 11-36 months). Twenty-nine patients (58%) responded with excellent control (pain free), 18 (36%) obtained good control (50%-90% relief), and three (6%) experienced treatment failure. The median time to pain relief was 1 month (range 1 day-6.7 months). Responses remained consistent for up to 3 years postradiosurgery in all cases except three (6%) in which the patients had pain recurrence at 5, 7, and 10 months. At 2 years, 54% of patients were pain free and 88% had 50% to 100% relief. A maximum radiosurgical dose of 70 Gy or greater was associated with a significantly greater chance of complete pain relief (72% vs. 9%, p = 0.0003). Three patients (6%) developed increased facial paresthesia after radiosurgery, which resolved totally in one case and improved in another. No patient developed other deficits or deafferentation pain. The proximal trigeminal nerve and root entry zone, which is well defined on magnetic resonance imaging, is an appropriate anatomical target for radiosurgery. Radiosurgery using the gamma unit is an additional effective surgical approach for the management of medically or surgically refractory trigeminal neuralgia. A longer-term follow-up review is warranted.
一项多机构研究旨在评估伽玛刀立体定向放射外科治疗三叉神经痛的技术、剂量选择参数及治疗结果。五个中心的50例患者接受了以4毫米等中心针对神经根入区的放射外科手术。32例患者曾接受过手术，平均手术次数为2.8次（范围1 - 7次）。本研究中放射外科手术的靶剂量为60至90 Gy。放射外科手术后的中位随访期为18个月（范围11 - 36个月）。29例患者（58%）获得了极佳的疼痛控制（无痛），18例（36%）获得了良好的控制（疼痛缓解50% - 90%），3例（6%）治疗失败。疼痛缓解的中位时间为1个月（范围1天 - 6.7个月）。除3例（6%）患者在术后5、7和10个月出现疼痛复发外，所有病例在放射外科手术后长达3年的时间里反应保持一致。在2年时，54%的患者无痛，88%的患者疼痛缓解50%至100%。最大放射外科剂量70 Gy或更高与完全疼痛缓解的可能性显著增加相关（72%对9%，p = 0.0003）。3例患者（6%）在放射外科手术后出现面部感觉异常加重，其中1例完全缓解，另1例有所改善。没有患者出现其他神经功能缺损或去传入性疼痛。在磁共振成像上清晰可见的三叉神经近端和神经根入区是放射外科手术合适的解剖靶点。使用伽玛刀进行放射外科手术是治疗药物或手术难治性三叉神经痛的另一种有效手术方法。有必要进行长期随访复查。
