Leksell C型伽玛刀治疗三叉神经痛126例疗效观察

Clinical analysis of Leksell C gamma knife radiosurgery for 126 patients of trigeminal neuraligia

目的评价LeksellC型伽玛刀治疗三叉神经痛的疗效及相关因素。方法应用美国GE1．5TMRI定位，1．4mm无间距扫描，LeksellC型伽玛刀治疗三叉神经痛126例。治疗靶点为三叉神经半月节近感觉神经根入脑干段，采用4mm准直器，沿三又神经设置2个靶点。中心剂量为85~90Gy，以70％等剂量曲线覆盖靶点，脑干边缘剂量为15～16Gy。结果随访时间6～30个月，平均14个月。治愈95例，疗效显著19例，显效7例，无效5例，总有效率（治愈＋疗效显著＋显效）为96％。出现面部感觉异常等并发症9例。结论LeksellC型伽玛刀治疗三叉神经痛安全有效，但存在面部感觉异常等并发症，远期疗效有待评价。

Objective To assess the efficacy of Leksell C gamma knife for primary trigeminal neuraligia and the factors related to the effectiveness. Methods One hundred and twenty-six patients with primary trigeminal neuralgia were orientated by GE 1. 5T MRI, 1.4 mm scan without interval and treated by Lekcell C gamma knife. The entry zone of trigeminal nerve root was fixed as the radiotherapeutic target with the collimator of 4mm. Two isocenter points were placed along trigeminal nerve root. The radiation dose at brainstem surface was between 15Gy and 16Gy,and the central dose was between 85Gy and 90Gy. Results All patients were fol- lowed up from 6 to 30 months,median followed up duration was 14 months. Pain completely disappeared in 95 cases, 19 patients were effectively improved, 7 patients were improved and 5 patients were ineffective. The whole efficiency rate was about 96%, and there were 9 patients existed facial feeling disturbance. Conclusion Treatment for trigeminal neuralgia with Leksell C gamma knife is effective and safe, but facial feeling disturbance exists. The long-term effect of gamma knife radiosurgery for trigeminal neuralgia needs to be further studied.