原发性三叉神经痛的伽玛刀治疗

Gamma knife radiosurgery for treatment of primary trigeminal neuralgia

目的:研究原发性三叉神经痛伽玛刀治疗的靶点—效应关系和剂量—效应关系。方法:对伽玛刀治疗的63例原发性三叉神经痛进行回顾性分析,对三叉神经半月节、三叉神经近端的靶点—效应和剂量—效应进行统计学处理。结果:63例经6～72个月,平均为36.74个月的随访,疼痛消失37例(58.73%),疼痛缓解90%以上12例(19.05%),缓解50%以上9例(14.29%),无效5例(7.93%),总有效率92.07%。治疗靶点选择三叉神经根近端的疗效对比三叉神经半月节有显著差异(P<0.05)。中心剂量120Gy与120Gy以下在疗效上有显著性差异(P<0.05)。结论:选择三叉神经根近端为靶点,中心剂量在120Gy是最佳治疗方案。同时三叉神经根在MRI上的长度对治疗效果有一定影响,如基底环Y轴按平行眦听线(CM)向前开放15度角的直线安装,则断层扫描可获得良好的神经全程显示效果。

Objective To study the effects of target and dose on treating primary trigeminal neuralgia of gamma knife.Method A review was made for 63cases of primary trigeminal neuralgia that were treated with gamma knife,the chosen target was the root of trigeminal nerve just anterior to pons and trigeminal ganglion.The statistic analysis was accepted in the efficien-cy of treatment between different dose and target.Results In63patients,mean followed-up36.2months(range6to72).The pain completely disappeared in37cases(58.7%),the pain basically disappeared in12cases(19.1%),more than50%pain relief occured in9cases(14.3%),and in5patients(7.9%)the pain was unchanged.The total success rate was92.1%.There was sig-nifficant difference in pain relief when compared between the different chosen target(P<0.05),and the doses<120Gy to≥120Gy (P<0.05).Conclusion The preferable doses should be120Gy and the best target is the root of trigeminal nerve.The shown length of the root of trigeminal nerve on MR imaging affects the clinical outcome.Try angling the Y-axis of the coordinate frame angle of 15°,the Y-axis runs parallel with CM line then a longer nerve in MRI scanning will be shown .