原发性三叉神经痛的再次伽玛刀治疗

REPEATED GAMMA KNIFE RADIOSURGERY FOR PRIMARY TRIGEMINAL NEURALGIA

目的：分析原发性三又神经痛患者接受再次伽玛刀治疗的临床疗效、复发及并发症情况。方法：选取自1995年9月至2009年12月，52例首次伽玛刀治疗无效或复发的原发性三叉神经痛患者进行了再次伽玛刀治疗。再次治疗中心剂量为70～80Gy，平均77．2Gy。再次治疗靶点位置较首次治疗前移，两次治疗容积叠加约50％。本组采用巴罗神经学研究所（Barrow Neurological Institute，BNI）三又神经痛评分标准对疗效进行了评估。结果：本组随访从治疗后1个月开始，随访平均时间为58个月。本组治疗有效46例，包括BNI I级22例，BNI II级14例，BNI III级10例，总有效率为88．5％（46／52）。5例患者在治疗后6～72个月出现复发，复发率为10．9％（5／46）。本组病例治疗后出现面部麻木者10例、面部感觉异常者2例，并发症发生率为23．1％（12／52）。结论：再次伽玛刀治疗安全有效，可以作为首次治疗无效或复发原发性三又神经痛患者的可靠治疗方法之一。

Objective： To analyze the clinical effects, reoccurrence and complications of repeated gamma knife radiosurgery for primary trigeminal neuralgia （TN）. Methods： From September 1995 to December 2009, 52 patients underwent repeated gamma knife radiosurgery for recurrent or refractory TN. The mean repeated prescription dose was 77.2 Gy （range of 70-80 Gy）.The target of repeated gamma knife was placed anterior to the target of initial treatment so that two radiosurgical volumes overlapped about 50%. The outcomes were assessed using the Barrow Neurological Institute （BNI） pain scale. Results： The follow-ups began at 1 month after repeated gamma knife radiosurgery, and the mean follow-up duration was 58 months. A total of 46 patients got pain free or relieved significantly, including 22 BNI I patients, 14 BNI II patients and 10 BNI III patients, and the total effective rate was 88.5% （46/52）. After repeated treatment, 5 patients suffered a relapse at 6 - 72 months after treatment and the recurrence rate was 10.9% （ 5/46 ） . Ten patients had facial numbness, 2 had facial paresthesia, the rate of complications was 23.1% （ 12/52 ） . Conclusion： Based on the safety and efficacy of this treatment, repeated gamma knife radiosurgery can be one of the reliable treatment options for management of recurrent or refractory primary trigeminal neuralgia.