老年患者原发三叉神经痛的射波刀治疗

Cyberknife radiosurgery in treating primary trigeminal neuralgia in elderly

目的探讨射波刀治疗老年患者原发性三叉神经痛的疗效及安全性。方法选取2016年5月~2018年12月解放军总医院第一医学中心神经外科行射波刀治疗的老年患者原发性三叉神经痛40例(老龄组),同期治疗低龄组40例,诊断依靠磁共振特征除外肿瘤及其他疾病。老龄组靶点选择在三叉神经根入桥脑段前2.05~3.03mm处,神经治疗长度6.01~7.95mm,准直器选择5&7.5mm,处方剂量为60~64Gy,剂量归一80%,靶区覆盖率75.08%~100%。随访时间1~31个月。评价两组患者疼痛缓解程度、缓解时间、麻木发生时间、麻木程度,复发及复发时间差异性。结果老龄组40例患者有效38例(95.0%),无效2例(5.0%);疼痛消失期0~210d,平均34d;面部麻木4例(10.0%);麻木发生时间1~12月,平均4个月;复发0例。低龄组40例有效36例(90.0%),无效4例(10%);疼痛消失期0~120d,平均36d;面部麻木11例(27.5%);麻木发生时间2~12个月,平均6.5个月;复发1例,复发时间为6个月。老龄组与低龄组比较,起效时间、疼痛缓解程度、麻木发生时间、麻木程度差异均无统计学意义(P>0.05)。结论射波刀治疗老年患者原发性三叉神经痛是安全有效的,可作为初始治疗首选。

Objective To investigate the safety and effectiveness of CyberKnife radiosurgery of primary trigeminal neuralgia in elderly. Methods We summarized 40 cases of primary trigeminal neuralgia in elderly group and 40 cases of young age group treated by Cyberknife in neurosurgery of The First Medical Center of PLA General Hospital from May 2016 to December 2018. The diagnosis relied on magnetic resonance features except tumors and other diseases. Target location in elderly group for brain trigeminal nerve root into the bridge section of 2.05-3.03 mm,standard for 5 &7.5 mm collimator,prescription dose 60-64 Gy ,curve range is 75.08%-100%. Follow-up time ranged from 1 to 31 months. To evaluate the degree of pain relief,time of relief,degree of numbness,time of numbness,recurrence and recurrence time and compared with the control group. Results In elderly group pain relief was initially experienced by 38 out of 40 cases (95.0%),invalid 2 cases(5%). The median time to pain relief was 34 days (range,0–210 d). Posttreatment numbness occurred in 4 (10.0%) of the cases treated. The mean time of presence of posttreatment numbness was 4 months (rang,1-12 m). In young age group pain relief was initially experienced by 36 out of 40 cases (90.0%),invalid 4 cases(10.0%). The median time to pain relief was 36 days (range,0–120 d). Posttreatment numbness occurred in 11 (27.5%) of the cases treated. The mean time of presence of posttreatment numbness was 6.5 months (rang,2-12 m).1 case had recurrence and the recurrence time was 6 months. Compared with the young age group,there were no significant differences in onset time,pain relief degree,numbness time and numbness degree in elderly group (P > 0.05). Conclusions It is safe and effective to treat primary trigeminal neuralgia in elderly with cyberknife,and it can be the first choice for initial treatment.