重复伽玛刀治疗原发性三叉神经痛的临床研究  

Treatment outcome of repeat gamma knife radiosurgery for primary trigeminal neuralgia

作　　者：杜春发[1] 张志远[1] 徐德生[1] 郑立高[1] 

机构地区：[1]天津医科大学附属第二医院神经外科伽玛刀中心,天津300211

出　　处：《中华神经医学杂志》2008年第10期1044-1047,共4页Chinese Journal of Neuromedicine

摘　　要：目的探讨重复伽玛刀治疗原发性三叉神经痛（TN）的可行性、相关标准、疗效。方法选择自1995年1月至2006年2月接受初次伽玛刀（GK1）治疗的277例TN患者，靶点选择三叉神经感觉根近桥脑处，中心剂量为70～80Gy；对其中23例无效和15例复发者行第二次伽玛刀（GK2）治疗，中心剂量为65～80Gy，50％等剂量线限定靶点，33例仍将三叉神经感觉根近桥脑处作为靶点，5例采用双靶点治疗。结果（1）GK2治疗后疼痛缓解时间：GK2治疗后所有患者均得到满意的电话随访，随访时间为12～108个月（平均55个月），出现疼痛缓解时间为1～180d（平均120d）。（2）治疗有效率：GK1治疗后有效率为91．7％（254／277）；GK2治疗后为84．2％（32／38），其中GK1治疗后23例无效者和15例复发者治疗有效率分别为73．9％（17／23）和100％（15／15），两组差异有统计学意义（P=0．045）。（3）并发症：GK1治疗后发生面部麻木或麻痹30例（10．8％），GK2治疗后新发生8例，新并发症的发生率为21．1％。结论伽玛刀是治疗TN安全有效的方法。严重副反应少。初次治疗后无效或复发者再次行伽玛刀治疗仍然有效，且复发者效果好于无效者。Objective To assess the feasibility, indications and therapeutic effect of repeat gamma knife radiosurgery for treatment of primary trigeminat neuralgia. Methods From January 1995 to February 2006, 277 patients with primary trigeminal neuralgia underwent stercotactic radiosurgery targeting the cisternal trigeminal nerve with a maximal central dose of 70-80 Gy. A second gamma knife radiosurgery with a maximal central dose of 65-80 Gy was performed in 23 patients with refractory and 15 with recurrent trigeminal neuralgia after the primary surgery. The 50% isodose line encompassed the target area for radiation. The trigeminal root entry zone was included in a single target area in 33 patients, and in 5 patients, two target areas were chosen. Results All patients were followed up for 12 to 108 months （mean 55 months） by telephone. The pain relief lasted for 1 to 180 days （mean 120 days） after the second gamma knife radiosurgery. The primary stereotactic radiosurgery resulted in a complete or partial pain relief rate of 91.7%（254/277）. In the 23 patients with refractory trigeminal neuralgia, the second radiosurgery achieved a pain relief rate of 73.9% （17/23）, significantly lower than the rate of 100% （15/15） in the 15 patients with recurrent trigeminal neuralgia （P=0.045）. Facial numbness or paresthesia occurred in 30 patients （10.8%） after the primary radiosurgery, and in another 8 patients （21.1%） after the second surgery. Conclusion Gamma knife stereotactic radiosurgery is safe and effective and causes few complications for relieving trigeminal neuralgia. A repeat gamma knife stereotactic radiosurgery is also effective for management of recurrent or refractory trigeminal neuralgia, especially in recurrent cases.

关 键 词：三叉神经痛 立体定向放射外科 伽玛刀 

分 类 号：R745.11[医药卫生—神经病学与精神病学]