伽马刀治疗微血管减压术后复发三叉神经痛的效果分析

Gamma knife therapy for recurrent trigeminal neuralgia after microvascular decompression

目的比较伽马刀首次治疗三叉神经痛(trigeminal neuralgia,TN)和再次治疗微血管减压(microvascular decompression,MVD)后复发TN的结果,评价伽马刀治疗MVD后复发TN的疗效。方法回顾性分析2011年6月至2017年9月四川大学华西医院经伽马刀治疗的TN患者676例的临床资料,其中46例患者有MVD病史。选择三叉神经根为放射治疗靶点,平均的最大放射剂量为84.7 Gy(70~90 Gy)。术后进行门诊及电话随访,进行疗效、并发症及满意度的评价。结果随访时间平均为6.4±1.6年(2.1~8.5年)。12月内,无和有MVD病史TN患者的疼痛缓解率分别为91.56%和77.58%;最后一次随访,疼痛复发率分别为44.37%和47.75%;并发症发生率分别为12.7%和13.0%。无MVD病史的患者的疼痛缓解率明显高于有MVD的患者(P=0.02),长期随访两组疼痛复发率(P=0.85)及并发症(P=0.62)均无统计学差异。结论对于曾经接受过MVD治疗的复发性TN患者,伽马刀是一种有效且安全的治疗方式。

Objective The purpose of this study was to evaluate the effect of gamma knife on recurrent trigeminal neuralgia after microvascular decompression by comparing the results of the first treatment of trigeminal neuralgia and the re-treatment of recurrent trigeminal neuralgia after microvascular decompression.Methods From June 2011 to September 2017,Clinical data of 676 patients with trigeminal neuralgia treated with gamma knife in west China hospital of sichuan university were retrospectively analyzed,46 of whom had a history of MVD.Trigeminal nerve root was selected as the target of radiotherapy,and the average maximum prescription dose was 84.7 Gy(70~90 Gy).Postoperative outpatient and telephone follow-up were conducted to evaluate the efficacy,complications and satisfaction.Results The mean follow-up time was 6.4±1.6 years(2.1~8.5 years).Within 12 months,the pain relief rates of patients without or with MVD were 91.56% and 77.58%,respectively.At the last follow-up,the recurrence rates of pain were 44.37% and 47.75%,respectively.The incidence of complications was 12.7% and 13.0%,respectively.The pain relief rate of patients without MVD was significantly higher than that of patients with MVD(P=0.02),and the recurrence rate(P=0.85) and complications(P=0.62) of the two groups showed no statistical difference during long-term follow-up.Conclusion Gamma knife is an effective and safe treatment for recurrent trigeminal neuralgia patients who have been treated with MVD.