伽玛刀治疗三叉神经痛照射剂量研究

Study of radiation dose of gamma knife radiosurgery for primary trigeminal neuralgia

目的 ;研究伽玛刀治疗原发性三叉神经痛的最佳照射剂量。方法选择2004年1月~2010年3月期间经保守治疗无效的原发性三叉神经痛患者进行伽玛刀治疗。根据不同的照射剂量随机分为高剂量组（80~85Gy）和低剂量组（70~75 Gy）,治疗后定期随访,进行疗效分析。结果本组总计65例患者,随访60例,失访5例,随访率92.3%,随访期12~78个月,平均随访期36个月。对两组共60例患者进行了统计学分析,其中高剂量组25例,低剂量组35例。高剂量组1例无效,有效率96%,低剂量组2例无效,有效率94.3%,两组有效率无差异（P〉0.05）。高剂量组出现面部麻木17例,并发症发生率68%,低剂量组出现面部麻木7例,并发症发生率20%,两组并发症发生率有显著差异（P〈0.05）。高剂量组治疗后疼痛完全缓解时间为2.51个月,低剂量组治疗后疼痛完全缓解时间为2.67个月,两组疼痛缓解时间无差异（P〉0.05）。结论伽玛刀治疗原发性三叉神经痛安全有效,70~75 Gy应作为最佳照射剂量。

Objective To Study best radiation dose of gamma knife radiosurgery for primary trigeminal neuralgia.Methods Between January 2004 and March 2010,65 patients with primary trigeminal neuralgia were treated with gamma knife radiosurgery.The patients were randomly divided into high-dose group（80-85Gy） and low-dose group（70~75Gy）.After treatment,the patients were followed-up for long time.Results Total of 65 patients in the group,60 patients were followed up,lost in 5 cases,follow-up rate was 92.3%,follow-up period of 12~78 months,average follow-up period of 36 months.We followed 60 cases of two groups for statistical analysis,of which 25 cases of high-dose group,low dose group of 35 patients.1 case of high-dose group was ineffective,96% efficient,low-dose group 2 cases were ineffective,efficiency 94.3%,there were no differences between the two groups（P 0.05）.High dose group showed 17 cases of facial numbness,68% complication rate,low-dose group had 7 cases of facial numbness,20% complication rate,complication rate of the two groups were significantly different（P0.05）.High-dose group after treatment,complete pain relief time was 2.51 months,the low dose group after treatment,complete pain relief time was 2.67 months,the two groups was no difference in pain relief time（P 0.05）.Conclusion Gamma knife radiosurgery was safe and effective for primary trigeminal neuralgia.70~75Gy radiation dose should be as the most suitable.