伽玛刀和射波刀治疗三叉神经痛的临床观察

A CLINICAL STUDY OF GAMMA KNIFE AND CYBERKNIFE FOR TRIGEMINAL NEURALGIA

目的:评价伽玛刀及射波刀治疗原发性三叉神经痛病例的治疗效果、起效时间和随访观察,评价立体定向放射外科治疗原发性三叉神经痛的临床效果。方法:27例原发性三叉神经痛患者经伽玛刀治疗10例,经射波刀治疗17例。靶点选择在三叉神经根入桥脑段前3.0mm处,依据Bris-man疗效判定标准分析临床治疗效果。结果:伽玛刀组10例平均随访时间7个月,治愈和疗效显著9例,1例无效;射波刀组17例平均随访时间11个月,治愈和疗效显著15例,无效2例。结论:伽玛刀、射波刀治疗原发性三叉神经痛具有可靠疗效。射波刀与伽玛刀相比较,前者无创、无框架、非等中心、非共面、非聚焦照射为其优点,后者精度较高,定位更为准确。靶点选择和精确定位是治疗成功的关键。

Objective： To evaluate the clinical outcomes,onset time and follow-up of patients with idiopathic trigeminal neuralgia treated with Gamma Knife Stereotactic Radiosurgery（GKSR） and Cyberknife（CK） for assessing the clinical efficacy of stereotactic radiosurgery on idiopathic trigeminal neuralgia.Methods： The outcomes in 27 patients with idiopathic trigeminal neuralgia who underwent GKSR（10 patients） or CK（17 patients） were retrospectively reviewed.The anatomical targets were located at the proximal 3 mm of trigeminal nerve roots entering / emerging from the anterior pons.The clinical efficacy was assessed using Brisman standards.Results： For the GKSR group,the follow-up period ranged from 5 to 12 month（caveraged 7 months）.9 patients achieved significant relief after a mean latency of one month,one patient had no improvement.For the CK group,the follow-up period ranged from 6 to 21 month（averased 11 months）.15 patients achieved complete and significant relief,and the other two patients had no improvement.Conclusions： Both GKSR and CK were effective for the treatment of idiopathic trigeminal neuralgia.GKSR was frameless,noninvasive,non-coplanar and non-focal.Whereas CK has the priority of high precision in localization.Treatment target selection and accurate location were crucial for the success of stereotactic radiosurgery.