射波刀治疗原发三叉神经痛105例分析

Cyberknife radiosurgery for primary trigeminal neuralgia analysis of 105 cases

目的探讨射波刀治疗原发性三叉神经痛治疗效果,总结治疗经验。方法总结2016年5月至2019年3月解放军总医院第一医学中心神经外科行射波刀治疗的105例原发性三叉神经痛患者治疗经验及效果。靶点选择在三叉神经根入桥脑段前2.03~3.03mm处,平均2.77mm,神经治疗长度6.01~7.96mm,平均7.11mm,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67.61%~100%。随访时间1~32个月。随访评价患者疼痛缓解时间及程度,麻木发生时间及程度,复发及复发时间?结果本组105例患者有效97例(92.4%),无效8例(7.6%);疼痛消失期0~210天,平均32.7天;面部麻木19例(18.1%);麻木发生时间1~12月,平均5.8月;复发1例,复发时间为6个月。神经治疗长度6~7mm组与7~8mm组对比,起效时间有明显差异(P=0.001<0.05),疼痛缓解程度无明细差异(P=0.754>0.05),麻木发时间无明显差异(P=0.267>0.05),麻木程度无明显差异(P=0.181>0.05)。结论射波刀治疗原发性三叉神经痛靶区治疗神经长度6~8mm,处方剂量60~64Gy是安全有效的,无严重并发症。靶点选择和精确定位是治疗成功的关键。

Objective To investigate the effect of CyberKnife radiosurgery for primary trigeminal neuralgia and summarize the experience of treatment.Methods We summarized 105 cases of primary trigeminal neuralgia treated by Cyberknife in neurosurgery of the First Medical Center of PLA General Hospital from May 2016 to March 2019.The target is located 2.03~3.03 mm infront the segment that trigeminal nerve enter the pons,slected 5&7.5 mm collimator,prescription dose 60~64 Gy,target volume treated at/above dose is 67.61%~100%.Follow-up time ranged from 1 to 32 months.To evaluate the degree of pain relief,time of relief,degree of numbness,time of numbness,recurrence and recurrence time.Results In our study pain relief was initially experienced by 76 out of 82 patients(92.4%).The median time to pain relief was 32.7 days(range,0~210 d).Posttreatment numbness occurred in 19(18.1%)of the patients treated.The mean time of the presence of posttreatment numbness was 5.8 months(rang,1~12 m).One case had recurrence and the recurrence time was 6 months.Compared with the 6~7 mm group,there were significant differences in onset time(P=0.001<0.05)in 7~8 mm group,no significant differences in pain relief degree(P=0.754>0.05),numbness time(P=0.267>0.05),and numbness degree(P=0.181>0.05).Conclusion It is safe and effective to treat primary trigeminal neuralgia with Cyberknife at target nerve length of 6~8 mm and a prescription dose of 60~64 Gy.We found no serious complications.Target selection and accurate targeting are the key to successful treatment.