继发性三叉神经痛治疗方法的选择

TREATMENT STRATEGIES OF SECONDARY TRIGEMINAL NEURALGIA

目的探讨治疗继发性三又神经痛的方法及其临床疗效分析。方法回顾性分析我院自1997年7月-2005年10月继发性三又神经痛59例，采用显微手术40例，采用伽玛刀治疗19例，照射靶点为引起三又神经痛的病灶。结果二组均无死亡病例，显微手术组：肿瘤全切32例，次全切除8例，术后三又神经痛均消失，面部感觉减退6例，加重2例。伽玛刀治疗组：平均随访随访6个月～6年（平均68个月），影像学证实2例（10．5％）基本消失，11例（57．9％）明显萎缩，5例（26．3％）体积无变化。肿瘤总控制率94．7％。结论应根据引起三又神经痛的原因采取不同的方法，显微手术全切病灶可达到根治的目的，但累及海绵窦等结构不能全切的病灶及中小型肿瘤可采取伽玛刀治疗，可以有效地控制肿瘤生长、改善临床症状，保护瘤周颅神经的功能。

Objective To investigate the potential role of microsurgical treatment and gamma knife surgery （GKS） on secondary trigeminal neuralgia （TN）. Methods The study included 59 patients （39 female and 20 male） treated by microsurgery and GKS between July 1997 to October 2005. Two different treatment groups were established. 40 patients （Group Ⅰ） were treated by microsurgery with different approaches. 19 patients （Group Ⅱ） were treated by GKS with targeting the lesion. Results No deaths were observed. In group I total resection were achieved in 32 patients and subtotal resection in the other 8 patients. The cranial nerve deficits were improved in 38 patients and worsened in 2 patients. In group Ⅱ the mean radiological followup period was 68 months. 2 patients （10. 5%） showed nearly disappearance of tumor, 11 patients （57.9%）showed reduction, 5 patients（26.3%） showed no change, 1 patients （5.3%）showed enlargement, and the overall tumor control rate was 94.7%. Conclusion Treatment strategies differed according to lesion type, topography, and size, as well as visibility of the fifth cranial nerve in the prepontine cistern. Microsurgery with skull base approach can improve total tumor resection rate. Nevertheless, the low rate of morbidity and the greater comfort afforded the patient render GKS safer and thus more attractive.