Kondziolka D, Perez B, Flickinger J C, Habeck M, Lunsford L D
Department of Neurological Surgery, University of Pittsburgh Medical Center, PA 15213, USA.
Arch Neurol. 1998 Dec;55(12):1524-9. doi: 10.1001/archneur.55.12.1524.
Trigeminal neuralgia is a disabling pain syndrome responsive to both medical and surgical therapies. Stereotactic radiosurgery using the gamma knife can be used to inactivate a specified volume in the brain by cross firing 201 photon beams. We evaluated pain relief and treatment morbidity after trigeminal neuralgia radiosurgery.
All evaluable patients (n = 106) had medically or surgically refractory trigeminal neuralgia. A single 4-mm isocenter of radiation was focused on the proximal trigeminal nerve just anterior to the pons. For follow-up an independent physician who was unaware of treatment parameters contacted all patients.
After radiosurgery, 64 patients (60%) became free of pain and required no medical therapy (excellent result), 18 (17%) had a 50% to 90% reduction (good result) in pain severity or frequency (some still used medications), and 9 (9%) had slight improvement. At last follow-up (median, 18 months; range, 6-48 months), 77% of patients maintained significant relief (good plus excellent results). Only 6 (10%) of 64 patients who initially attained complete relief had some recurrent pain. Radiosurgery dose (70-90 Gy), age, surgical history, or facial sensory loss did not correlate with pain relief. Poorer results were found in patients with multiple sclerosis. Twelve patients developed new or increased facial paresthesias after radiosurgery (10%). No patient developed anesthesia dolorosa. There was no other procedural morbidity.
Gamma knife radiosurgery is a minimally invasive technique to treat trigeminal neuralgia. It is associated with a low risk of facial paresthesias, an approximate 80% rate of significant pain relief, and a low recurrence rate in patients who initially attain complete relief. Longer-term evaluations are warranted.
三叉神经痛是一种使人丧失能力的疼痛综合征，对药物和手术治疗均有反应。使用伽玛刀的立体定向放射外科手术可通过交叉发射201束光子束来使脑内特定体积失活。我们评估了三叉神经痛放射外科手术后的疼痛缓解情况及治疗并发症。
所有可评估的患者（n = 106）均患有药物或手术治疗无效的三叉神经痛。将单个4毫米的辐射等中心聚焦于脑桥前方的三叉神经近端。随访时，由一名不了解治疗参数的独立医生联系所有患者。
放射外科手术后，64例患者（60%）疼痛消失且无需药物治疗（效果极佳），18例（17%）疼痛严重程度或发作频率降低了50%至90%（效果良好）（部分患者仍使用药物），9例（9%）有轻微改善。在最后一次随访时（中位数为18个月；范围为6至48个月），77%的患者维持了显著的疼痛缓解（良好及极佳效果）。最初达到完全缓解的64例患者中仅有6例（10%）出现了一些复发性疼痛。放射外科手术剂量（７０－９０ Gy）、年龄、手术史或面部感觉丧失与疼痛缓解无关。多发性硬化症患者的治疗效果较差。12例患者在放射外科手术后出现了新的或加重的面部感觉异常（10%）。没有患者发生痛性麻木。未出现其他手术并发症。
伽玛刀放射外科手术是治疗三叉神经痛的一种微创技术。它与面部感觉异常的低风险、约80%的显著疼痛缓解率以及最初达到完全缓解患者的低复发率相关。有必要进行长期评估。
