伽马刀与显微外科手术对三叉神经痛显微血管减压术后复发患者的疗效对比研究

Efficacies of gamma knife and neuro-microsurgery in patients with recurrent trigeminal neuralgia after microvascular decompression:a comparative study

目的明确伽马刀与显微外科手术在治疗三叉神经痛(TN)显微血管减压术(MVD)后复发患者中的疗效差异。方法选择自2011年1月至2018年12月陆军军医大学大坪医院神经外科收治的65例MVD术后复发TN患者进入研究,其中接受伽马刀治疗患者40例,接受二次显微外科手术治疗患者25例。采用美国Barrow神经研究所(BNI)提出的疼痛分级评价患者术后疗效及随访3年后疗效,Ⅰ~Ⅲ级定义为疼痛缓解。结果伽玛刀治疗组患者治疗后4~10周内面部疼痛逐渐减少直至消失。二次显微手术治疗组患者麻醉清醒后面部疼痛随即消失,或于随后1周内完全缓解。至术后第3年,随访结果显示,25例伽马刀治疗组患者中疼痛缓解17例(68.0%);17例二次显微手术治疗组患者中疼痛缓解16例(94.1%);2组患者疼痛缓解率差异有统计学意义(χ^2=4.100,P=0.043)。伽马刀治疗组患者并发症均为面部麻木,发生率为24.0%;二次显微手术治疗组患者中出现1例偏瘫,余均为面部麻木,并发症发生率为29.4%;2组患者并发症发生率差异无统计学意义(χ^2=0.010,P=0.921)。结论对于MVD术后复发TN患者,二次显微外科手术及伽马刀治疗均安全有效,其中显微外科手术疗效优于伽马刀治疗。

Objective To determine the difference of curative effects of gamma knife treatment and microsurgery on patients with recurrent trigeminal neuralgia(TN)after microvascular decompression(MVD).Methods From January 2011 to December 2018,65 patients with recurrent TN after MVD were enrolled in the study;40 patients received gamma knife treatment and 25 patients received secondary microsurgical treatment.Barrow Neurological Institute(BNI)proposed pain grading was used to evaluate the efficacies right after treatment and 3 years after follow-up in all patients,and grading I-III was defined as pain relief.Results Patients received gamma knife treatment had pain relief within 4-10 weeks of treatment and disappeared gradually;patients received secondary microsurgical treatment had disappeared facial pain immediately after waking up from anesthesia or completely alleviated facial pain within one week of treatment.Up to 3 years after surgery,follow-up results showed that 17 patients(68.0%)in the gamma knife treatment group had pain relief,and 16 patients(94.1%)in the microsurgical treatment group had pain relief;the difference in pain relief rate between the two groups was statistically significant(χ^2=4.100,P=0.043).Facial numbness was noted in the gamma knife treatment group,with an incidence of 24.0%;in the microsurgical treatment group,hemiplegia was noted in one patient and facial numbness was noted in the left ones,with complication rate of 29.4%;and the difference in complication rate between the two groups was not statistically significant(χ^2=0.010,P=0.921).Conclusion For patients with recurrent TN after MVD,secondary microsurgical treatment and gamma knife treatment are safe and effective,among which secondary microsurgical treatment is more effective than gamma knife treatment.