靶区解剖是否是三叉神经痛伽玛刀治疗显著因素?57例回顾性研究

Whether target anatomic factors are significant factors of the trigeminal neuralgia by gamma knife treatment 57 patient's respective research

目的评价三叉神经痛伽玛刀治疗长期随访中多个因素(特别是靶区解剖因素)对疗效及并发症等的影响。方法回顾性分析了57例随访超过2年的三叉神经痛伽玛刀治疗的患者,分析了12种因素(年龄,性别,侧别,病程,有无射频,靶区有无血管接触,剂量,靶区三叉神经桥池段暴露的长度,横径,层数,靶区桥小脑间隙宽度,三叉神经与脑干夹角)对疗效,并发症及复发率关系,统计方法为χ2检验Fisher确切概率法和Logistic回归。结果经过χ2检验Fisher确切概率法统计发现与疗效统计有关的因素为放射剂量≤80Gy,>80Gy(P=0.042<0.05,差异明显)其中>80Gy组的有效率为79.2%,无效率为25%;≤80Gy组的有效率为25%,无效率为75%,提示>80Gy组治疗效果优于≤80Gy组,未发现与并发症,复发的显著因素。结论伽玛刀治疗三叉神经痛长期随访疗效显著,并发症少。在规划时适当的提高剂量有助于提高疗效,并不增加副作用及复发率。未发现与并发症,复发有关的显著因素。靶区有无血管接触,剂量,靶区三叉神经桥池段暴露的长度,横径,层数,靶区桥小脑间隙宽度,三叉神经与脑干夹角靶区解剖不是疗效,并发症及复发的显著因素。本组资料样本量较少,仍需要更大样本的检验。

Objective Stereotactic radiosurgery is an increasingly used,and the least invasive,surgical option for Patients with trigeminal neuralgia（TN）.In this study,the authors Performed a retrospective evaluation of the safety and efficacy of this method for idiopathic TN. Methods A retrospective analysis in October 2005-October 2009 in-Patient treatment in our hospital＇s clinical Pathology imaging in suspected Primary trigeminal neuralgia,and were followed up.57 Patients underwent gamma-knife surgery were follow-up in our study.We recorded 5 species of materials of the anatomy include of the length of V5 in cerebellar-Pun-cistern,the exposé of the level numbers of the nerve,the diameter of the nerve of exposé,the distance of the interval between the incisures to the REZ,and the angle to V5 and the Pons.A kind of factor include of the anatomy factor of the target is conclude and analysis. Results Through the exact chi-square test,less-than 80 Gy group and beyond 80 Gy group is significant difference（P=0.0420.05）,rate of the Pain relief is 79.2% in the beyond 80 Gy are more than 25% in the less than 80 Gy. Conclusion Using the exact chi-square test and logistic regression found the affect curative effect is the dose.No factor can affect the recurrence and invalid.