伽玛刀单靶点治疗原发性顽固性三叉神经痛:73例随访观察

Single-target treatment for primary refractory trigeminal neuralgia with gamma knife: a follow-up observation of 73 cases

目的:评价伽玛刀单一靶点治疗顽固性三叉神经痛的疗效、安全性,以期为改善三叉神经痛患者的身心健康及生活质量提供干预方向。方法:回顾性分析1995-07/2003-06本院接受伽玛刀治疗的三叉神经痛患者73例,其中男31例,女42例,年龄35～79岁,平均61岁。病程1.5～29年,平均4.5年。所有的病例均设置单一靶点治疗,靶点部位选择在三叉神经入桥脑处,中心剂量70～90Gy,准直器为4mm。结果:伽玛刀治疗后全部患者在24h出院,出院后随访时间6～68个月不等,平均随访时间36.7个月。术后18例显效(24.7%),46例有效(63%),9例无效(12.3%)。症状缓解时间为2周～6个月,平均为3.5个月。治疗后症状复发6例,给予二次治疗,3例症状缓解,3例症状无变化。治疗后出现头痛呕吐反应3例,全部于1周后消失;面部麻木7例,无咀嚼肌运动障碍及角膜发干或溃疡发生。结论:伽吗刀治疗三叉神经痛安全、有效,能显著的缓解患者的疼痛,提高其生活质量。

AIM: To evaluate the effectiveness and safety of single target treatment of refractory trigeminal neuralgia with gmma knife, so as to provide therapeutic methods for improving the physical and mental health and quality of life of patients with trigeminal neuralgia.METHODS: From July 1995 to June 2003, 73 patients with refractory trigeminal neuralgia were treated with gmma knife.Totally 31 cases of all patients were male, 42 cases were female, ages from 35 years old to 79 years old, the average was 61 years old. The course of disease was from 1.5 years to 29 years, and the average course was 4.5 years. All patients were treated with single target.The target was positioned at the root entry zone of the trigeminal nerve.The maximum dose was between 70 and 90 Gy.Collimator was 4 mm.RESULTS: All patients discharged at 24 hours after treated with gmma knife. Follow up range was from 6 to 68 months, and mean range was 36.7 months. The pain was relieved completely in 18 cases (24.7% ), relieved partially in 46 cases (63% ),and unchanged in 9 cases (12.3% ). The symptoms changed from 2 weeks to 6 months, and the average was 3.5 months.Six cases experienced pain recurrence and were treated with second gamma knife radiosurgery, the clinical symptoms relieved in 3 cases and unchanged in 3 cases.Three cases experienced headache and vomiting after gamma knife radiosurgery and disappeared in 1 week, 7 cases experienced persistent facial numbness and none of all cases had dysfunction of masticatory muscle, dry eye and kerat ulcer.CONCLUSION: Gamma knife radiosurgery is a safe and effective method in the treatment of refractory trigeminal neuralgia. It can significantly relief pain and improve quality of life.