原发性三叉神经痛的第三次伽玛刀治疗的初步经验报告

The initial experience of a third gamma knife procedure for recurrent trigeminal neuralgia

目的通过对三次伽玛刀治疗原发性三叉神经痛病例的长期随访,评价治疗的安全性,有效性及并发症发生情况。方法自1996年11月至2014年10月之间,5例难治性三叉神经痛患者均进行了3次伽玛刀治疗。初次治疗时:中位最大剂量为75Gy(70～80Gy),第二次治疗为70Gy(50～80Gy),第三次治疗为65Gy(50～70Gy)。中位靶区最高累积剂量为215Gy(175～230Gy)。结果第三次伽玛刀后中位随访66月(44～72个月)。疼痛完全缓解4例,部分缓解1例。前两次治疗平均疼痛复发时间26个月(12～48个月)。第三次伽玛刀后平均起效时间为1.5个月(1～4个月)。并发症情况:5例患者均出现面部麻木症状,其中2例为伽玛刀治疗前即出现,2例为第二次伽玛刀后出现,1例为第三次伽玛刀后出现。咬肌无力及颞肌萎缩2例,1例在第二次之治疗后出现,1例第三次伽玛刀后出现。结论三次伽玛刀治疗原发性三叉神经痛安全有效,并发症的发生率与二次治疗相似。

Objective The purpose of this study was to assess the long-term outcome,efficacy,safety and complication in TN patients who required 3 radiosurgical procedures for recurrent or persistent pain.Methods Between November 1996 and October 2014,5 patients underwent 3 GKRS for recurrent or refractory TN.The median maximum target dose was 75 Gy（range70-80 Gy）for the first radiosurgical procedure,70 Gy（range 50-80 Gy）for the second,and 65 Gy（range 50-70 Gy）for the third procedure.The median cumulative target dose was 215 Gy（range 175-230 Gy）.Results The median follow-up after the third GKRS was 66 months（44-72 months）.Four patients reported initial complete pain relief following their third GKRS and one patient experienced partial relief.These five patients suffered recurrent TN following the first and second procedures at a mean interval of 26 months（12-48 months）.After the third radiosurgical procedure,the average time for pain relief is in 1.5 months（1-4 months）.Five patients described facial numbness or paresthesia.Two patients developed facial sensory dysfunction before the primary GKRS and 2 patients experienced sensory dysfunction following the second GKRS,one patient described facial numbness after the third procedure.Two patients described bite weakness.One patient experienced bite weakness following the second GKRS,another patient after the third procedure.Conclusion Long term observation of third GKRS for TN showed good pain relief and the incidence of complications is similar to repeat GKRS.