伽玛刀和甘油阻滞术治疗微血管减压术后复发三叉神经痛的比较

Comparision of gamma knife and glycerol rhizolysis for recurrent trigeminal neuralgia after microvascular decompression

目的探讨伽玛刀和甘油阻滞治疗微血管减压术后无效和复发三叉神经痛的疗效。方法选取2008年6月~2013年12月神经外科收治的采用伽玛刀和甘油阻滞术治疗微血管减压术后无效和复发三叉神经痛58例。采用巴罗神经学研究所(BNI)分级评定标准评定患者临床疗效。结果平均随访57.3个月(36~78个月),30例行半月节后根甘油阻滞、21例行伽玛刀治疗,伽玛刀治疗1年和3年有效率分别为85.7%、71.4%,甘油阻滞组1年和3年有效率分别为83.3%、56.7%。伽玛刀组面部麻木发生率16例(76%)、甘油阻滞组26例(86.7%),两组有效率和并发症发生率均无统计学差异。结论伽玛刀和半月节后根甘油阻滞对微血管减压术后复发三叉神经痛均有肯定疗效。伽玛刀创伤小、并发症较轻;半月节后根甘油阻滞操作简便,即时缓解率高。

Objective To investigate the efficacy of gamma knife radiosurgery （GKRS） and glycerol rhizolysis （GR） in the treatment of refractory and recurrent trigeminal neuralgia（TN） af- ter microvascular decompression（MVD）. Methods 58 patients who failed prior MVD were trea- ted with GKRS or GR in June 2008--2013. We evaluated the surgical outcomes using the Barrow Neurological Institute （BNI） pain intensity scale. Results The mean follow--up period period was 57. 3 months （range：36-78）. Among the 51 recurrent or persistent TN patients, 30 under-went GR,21 underwent GKRS. The pain relief rate in GKRS groups at 1 and 3 years were 85. 7% ,71.4% ,respctively. The pain relief rate in GR groups at 1 and 3 years were 83.3% ,56.7%, respctively. The incidence of facial numbness was 16 in the GKRS group （76%） and 26 in the GR group（86.7 %）, and there wasn＇t significant difference between the two groups （P〉0. 05）. Conclusion The treatment of recurrent TN after MVD with GKRS and GR is effective. The GKRS is minimaly invasive with less complications. GR is simple and has a high immediate remission rate.