Leksell伽玛刀治疗原发性三叉神经痛46例报告(英文)

Gamma Knife Treatment for Primary Trigeminal Neuralgia

目的 评估伽玛刀在治疗原发性三叉神经痛中的作用与地位。方法 用 1.5TeslaMRI行三维超薄立体定位快速扫描 ,对 4 6例原发性三叉神经痛病人行LEKSELL伽玛刀放射手术治疗 ,4mm准直器 ,中心剂量 70～ 90Gy。靶点设定为三叉神经感觉根入桥脑处。结果 用标准咨询法对病人进行疗效评估 ,放射手术治疗前后疼痛按Ⅰ～Ⅳ级评分 ,Ⅰ级 :无痛 ;Ⅱ级 :偶发疼痛 ,不需用药 ;Ⅲ级 :轻度疼痛 ,服药能控制 ;Ⅳ级 :疼痛不能用药控制。 4 6例病人中Ⅰ级 2 6例(5 6 .5 % ) ,Ⅱ级 9例 (19.5 % ) ,Ⅲ级 7例 (15 .2 % ) ,Ⅳ级 4例(8.6 % ) ,此外有 4例病人疼痛复发 ,并接受第二次伽玛刀手术治疗 ,症状完全缓解 ,3例病人 (6 .5 % )有迟发性的面部感觉丧失 ,无其他并发症发生。结论 伽玛刀放射外科手术是一种安全有效治疗三叉神经痛的高科技方法 ,应用性强 ,我们认为只要诊断成立 ,就可考虑施行伽玛刀手术治疗。

Objective To evaluate the role of Gamma Knife radiosurgery (RS) in the management of medically refractory trigeminal neuralgia (TN). Methods 46 cases with primary trigeminal neuralgia treated by gamma knife using MR for stereotactic localization. The 4mm secondary collimator helmet and a radiosurgical dose maximum of 70～90Gy were used. The isocenter was placed at the trigeminal sensory root adjacent to the pons identified on stereotactic MRI scans. Results Outcome was evaluated using a standardized questionnaire. Pain before and after RS was scored as level I-IV (I: no pain; II: occasional pain, not requiring medication; III: some pain, controlled with medication; IV: some pain, not controlled with medication). Among our 46 TN patients, 26(56.5%) experienced pain relief, II in 9 (19.5%), III in 7(15.2%) , and IV in 4 (8.6%). 4 cases recurred that received the second time of gamma knife treatment, and all of them have a good effect. 3 patients (6.5%) developed delayed loss of facial sensation following treatment, but no other complications were noted. Conclusions We believe that Gamma Knife radiosurgery is one of the safest and most effective treatments which are currently available for trigeminal neuralgia. We recommend early radiosurgical treatment for trigeminal neuralgia once the diagnosis is clearly established.