复发性药物难治性三叉神经痛二次伽玛刀个性化治疗研究

Personalized repeat Gamma Knife Radiosurgery treatment in patients with recurrent refractorytrigeminal neuralgia

目的回顾性分析复发性药物难治性三又神经痛（RRTN）患者二次伽玛刀（GKRS）治疗远期预后、不良反应，总结治疗经验。方法1998年8月1日至2014年10月1日期间于郑州大学第五附属医院伽玛刀中心行GKRS治疗，后出现复发并行二次GKRS治疗的患者随访资料，统计分析远期预后、面部麻木不良反应的影响因素。结果治疗剂量为二次GKRS治疗后远期达到满意预后（BNI-PSI-Ⅲa级）的有利因素；治疗剂量为治疗后远期出现面部麻木（BNI-NSBI-Ⅳ级）的危险因素，二次治疗间隔时间为治疗后远期出现面部麻木（BNI-NSⅢ-Ⅳ级）的有利因素；二次GKRS治疗远期预后与治疗剂量呈正相关；远期出现面部麻木不良反应与治疗剂量呈正相关，与二次治疗间隔时间呈负相关。结论RRTN患者二次GKRS治疗安全、有效，需根据患者自身情况给予个性化治疗。

Objective To analyze the prognosis and untoward effect in recurrent refractory trigeminal neuralgia （RRTN） patients who underwent repeat Gamma Knife Radiosurgery treatment （GKRS） retrospectively, and to summarize the experience of repeat Gamma Knife Radiosurgery treatment of recurrent refractory trigeminal neuralgia. Methods RRTN patients who treated with repeat GKRS during 1998.8. 1 to 2014. 10. 1 in Gamma Knife treatment Center of the Fifth Affiliated Hospital of Zhengzhou University were involved. The factors influencing long-term prognosis and facial numbness adverse reactions were statistically analyzed. Results Therapeutic dose was an independent factor that influence long-term prognosis of RRTN patients. Therapeutic dose was a dangerous factor that influence long-term facial numbness. Interval time between twice GKRS treatment was a favorable factor for facial numbness. Long-term prognosis of repeat GKRS treatment was positively correlated with therapeutic dose. Untoward effect of facial numbness after repeat GKRS treatment was positively correlated with therapeutic dose and negatively correlated with interval time between twice GKRS treatment. Conclusions Repeat GKRS for RRTN patients is safe and effective, but personalized treatment plan should be given according to the patient＇s own condition.