影响原发性三叉神经痛伽玛刀治疗效果的相关因素分析

目的探讨伽玛刀治疗原发性三叉神经痛的疗效及影响预后的因素。方法回顾性分析75例原发性三叉神经痛的患者行伽玛刀治疗的效果,均经OUR-XGD旋转式伽玛刀治疗,采用4—8mm准直器,半月节照射采用多靶点,三叉神经根照射采用单靶点或双靶点,中心剂量70—90Gy,脑干表面受量〈15Gy。通过随访患者疼痛发作的频率和程度的减轻评价疗效。结果随访时间为3～72个月,平均37．6个月,总有效率90．7％。4例患者2～3年后复发,6例在伽玛刀治疗后半年出现患侧面部麻木感,无其他并发症。经统计学分析,某些因素与疗效相关。结论伽玛刀治疗原发性三叉神经痛一种安全有效的方法,靶点选择、剂量选择、照射部位是影响预后的因素,而病史长短及疼痛分布与预后无相关性。     

原发性三叉神经痛的显微外科治疗

目的 :探讨原发性三叉神经痛的显微外科治疗及其疗效。方法 :根据术中探查有无明确的血管压迫三叉神经 ,分别采用显微血管减压术或感觉根部分切断术。 132例病人中 95例行血管减压术 ;37例行感觉根切断术。结果 :无手术死亡病例。随访 6个月 15年 ,治愈或好转 130例 ,有效率为     

三叉神经痛伽玛刀治疗前MRI扫描序列研究

目的探讨伽玛刀治疗三叉神经痛MRI定位的最佳扫描序列。方法选择2004年7月-2006年3月行伽玛刀手术的原发性三叉神经痛患者60例,随机分为3组,每组各20例。伽玛刀术前上头架定位,然后对3组分别采用快速自旋回波序列（Turbo Spin Echo,TSE）、增强三维小角度激发快速梯度回波序列（enhanced three-dimensiunal fast low angle shot,enhanced3D-FLASH）、三维结构干涉稳态序列（three-dimensional constructive interferencein steady state,3D-CISS）进行扫描,观察三叉神经及周围血管的显示情况。结果①TSE扫描20例三叉神经,14例显示优,血管显示一般。②增强3D-FLASH扫描三叉神经,18例显示优,2例显示良,周围血管显示优。③3D-CISS扫描三叉神经,20例均显示优,周围血管显示良。结论 3D-CISS和增强3D-FLASH序列的融合影像能够清晰地显示三叉神经根及周围血管,有利于伽玛刀的精确定位,具有较高的临床应用价值,可以作为伽玛刀治疗原发性三叉神经痛的常规定位方法。     

半导体激光穴位照射联合局部封闭治疗原发性三叉神经痛57例

目的探讨半导体激光穴位照射联合局部封闭治疗原发性三叉神经痛的临床疗效。方法57例原发性三叉神经痛患者根据不同疼痛部位采用不同穴位接触照射,每一穴位各照射3min,间隔2min;同时用2％利多卡因2．5mL＋25％硫酸镁溶液2．5mL对不同部位局部封闭浸润注射。结果57例患者随访3个月,总有效率为98．2％;随访6个月,总有效率为94．7％;随访1年,总有效率为89．5％;随访2年,总有效率为86．0％。结论半导体激光穴位照射联合局部封闭治疗原发性三叉神经痛,有较好的疗效且可反复多次治疗,尤其对无法进行手术的老年患者采用射频温控热凝治疗更适用。     

MRTA在三叉神经痛病因学诊断中的应用研究

目的探讨三又神经痛患者血管压迫的MRTA（磁共振断层血管成像）表现及其病因诊断价值。方法对216例临床上诊断为三叉神经痛的患者术前行MRTA检查，均行微血管减压术，MRTA表现并与手术结果进行对照。结果216例三叉神经痛患者MRTA显示有208例在患侧有血管接触后压迫：小脑上动脉80例（37．04％），小脑前下动脉36例（16．67％），小脑后下动脉17例（7．87％），基底动脉39例（18．05％），多根血管32例（14．81％），未发现血管12例（5．56％）；手术所见216例均有血管接触或压迫：小脑上动脉75例（34．72％），小脑前下动脉33例（15．28％），小脑后下动脉15例（6．95％），基底动脉38例（17．59％），多根血管34例（15．74％），动脉＋静脉14例（6．48％），静脉7例（3．24％）。结论MRTA能清晰显示三叉神经脑池段与毗邻血管之间的关系，对三叉神经痛患者是否有血管接触或压迫的判断具有较高的敏感度和准确度，为手术医生提供术前评估和指导术中治疗有重要价值。     

影响微血管减压术治疗三叉神经痛疗效的临床分析

目的 分析影响微血管减压术治疗三叉神经痛患者临床疗效的因素,以提高其治疗三叉神经痛的临床疗效.方法 选择经微血管减压术治疗三叉神经痛患者106例,术后完整随访以上患者的临床疗效,并根据责任血管类型、压迫程度和减压是否充分分组讨论.结果 动脉压迫与动静脉混合压迫和静脉压迫组间比较差异有统计学意义(P<0.01,P<0.05).责任血管与三叉神经根的压迫程度为单纯接触/粘连、接触/粘连和移位、三叉神经萎缩,组间比较差异有统计学意义(P<0.01,P<0.05).术中充分减压与不充分减压,组间比较差异有统计学意义(P<0.01).结论 动脉压迫且与三叉神经根单纯接触/粘连、术中充分减压的患者,术后临床疗效及其预后多为满意;反之应加强术后随访或辅助治疗.     

磁共振三维稳态进动快速成像诊断原发性三叉神经痛52例分析

目的：探讨磁共振三维稳态进动快速成像（three-dimensional fast imaging employing steady state acquisition ,3D-FI-ESTA）对原发性三叉神经痛的诊断价值。方法采用磁共振3D-FIESTA序列扫描52例原发性三叉神经痛患者的三叉神经出脑干段,并做多平面重建。分析患侧组及健侧组三叉神经出脑干段与邻近血管的关系。结果患侧组与健侧组神经血管接触阳性比例分别为52/53与35/51,神经受压推移比例分别为10/53与1/51,差异有统计学意义（ P＜0.05）。结论磁共振3D-FIESTA,可以清晰显示三叉神经与邻近血管的关系,为原发性三叉神经痛的诊断及治疗提供可靠的影像学依据。     

伽玛刀和射波刀治疗三叉神经痛的临床观察

目的:评价伽玛刀及射波刀治疗原发性三叉神经痛病例的治疗效果、起效时间和随访观察,评价立体定向放射外科治疗原发性三叉神经痛的临床效果.方法:27例原发性三叉神经痛患者经伽玛刀治疗10例,经射波刀治疗17例.靶点选择在三叉神经根入桥脑段前3.0mm处,依据Bris-man疗效判定标准分析临床治疗效果.结果:伽玛刀组10例平均随访时间7个月,治愈和疗效显著9例,1例无效;射波刀组17例平均随访时间11个月,治愈和疗效显著15例,无效2例.结论:伽玛刀、射波刀治疗原发性三叉神经痛具有可靠疗效.射波刀与伽玛刀相比较,前者无创、无框架、非等中心、非共面、非聚焦照射为其优点,后者精度较高,定位更为准确.靶点选择和精确定位是治疗成功的关键.     

立体定向放射（体部伽玛刀）治疗原发性肝癌的疗效分析

目的分析体部伽玛刀治疗肝癌的治疗效果。方法自2002年1月至2003年10月收治原发性肝癌病人152例。病理证实135例，采用同位素肿瘤FDG显像诊断17例，肿瘤最大径小于5cm者39例，大于5cm但小于10cm者91例，大于10cm者22例；单病灶者68例，双病灶者55例，3个病灶以上者29例。伴随上腹部不适、腹涨、食欲不振91例，伴随门静脉癌栓29例，黄疸27例，少中等量腹水12例；曾行肝脏手术治疗者31例，伽玛刀治疗前接受介人治疗56例。采用设备为OUR—QGD型立体定向体部伽玛射线放射治疗系统。处方等剂量线采用55％～70％等剂量包饶计划靶区；单次一般剂量2．8Gy～5Cy／次，治疗次数为8～13次，总放射剂量30．8Gy～50Gy；每日或隔日伽玛刀治疗。结果治疗后3个月总的有效率为81．0％(123／152)，6个月总的局部控制率及生存率分别为63．2％、66．5％；1年总的局部控制率及生存率分别为39．0％、41．0％。随访期内未见严重放射性并发症。结论本文采用伽玛刀对肝癌进行治疗，疗效比较满意，说明伽玛刀对肝癌是较好的局部治疗方式。副作用轻．随访期内未见严重放射性并发症。     

全身伽玛刀治疗体部恶性肿瘤1100例分析

目的 本文对我院应用深圳国产OUR-QGD立体定向伽玛射线全身治疗系统（全身伽玛刀）治疗体部恶性肿瘤1100例，进行了统计和分析，其中肺癌及转移性肺癌606例（55％），肝癌及肝转移癌116例（10．6％），食道癌98例（9％），胰腺癌72例（6．5％）等。方法 应用美国PICKER2000型螺旋CT行薄层扫描获得定位图像，在TPS治疗规划系统上进行三维图像重建和显示。根据肿瘤性质质、类型、部位、血管、神经、气管、食管、胃、肠、膀胱的毗邻关系制定适合的治疗计划，再行治疗方案的模拟显示、评估、修正，确定治疗次数5～9次，边缘剂量400~900cGy／次，等剂量曲线50％-90％。结果 1100例患者中，有临床症状者1004例（91．3％），有不同程度的改善，46例（4．2％）无临床症状治疗后无变化，30例（2．7％）症状加重，20例（118％）近期死亡；1100例患者中，840例患者治疗后2～4个月行CT／MRI影像复查，220例病灶完全消失（26．2％），550例病灶缩小（65．5％），42例病灶无变化（5％），18例出现转移（2．1％），10例病灶增大（I．2％）。临床总有效率为91.3％，影像有效率为91．7％。结论 全身伽玛刀治疗体部恶性肿瘤安全、可靠，近期疗效显著，值得推广应用。     

伽玛刀治疗原发性三叉神经痛疗效观察

目的 探讨伽玛刀治疗原发性三又神经痛的疗效.方法 2003年1月至2008年3月,我院应用伽玛刀治疗原发性三又神经痛120例;治疗靶点为三叉神经根,用4 mm准直器,靶点中心计量为80～90 Gy.疗效评估采用患者自我报告疼痛的控制程度及药物用量的变化.结果 所有患者进行了随访,平均随访期(20.0±4.5)个月.本组病例中治愈69例(57.5%);显效34例(28.3%)、有效12例(10.0%)、无效5例(4.2%);总有效率为95.8%.5例患者疼痛复发后行其他治疗.83例患者(69.2%)曾出现一过性、局限性的面部麻木.14例患者(11.7%)在疼痛缓解后留下持续性的面部麻木;部分患者还伴有味觉减退、口嚼无力等主诉.结论 伽玛刀治疗原发性三又神经痛能够显著缓解疼痛、提高生活质量,不良反应发生率较低:是一种较为理想的治疗方法.     

Repeat trigeminal nerve radiosurgery for refractory cluster headache fails to provide long-term pain relief

OBJECTIVE/BACKGROUND: Medically refractory cluster headache (MRCH) is a debilitating condition that has proven resistant to many modalities. Previous reports have indicated that radiosurgery for MRCH provides little long-term pain relief, with moderate/significant morbidity. However, there have been no reports of repeated radiosurgery in this patient population. We present our findings from the first reports of repeat radiosurgery for MRCH. METHODS: Two patients with MRCH underwent repeat gamma knife radiosurgery at our institution. Each fulfilled clinical criteria for treatment, including complete resistance to pharmacotherapy, pain primarily localized to the ophthalmic division of the trigeminal nerve, and psychological stability. Both patients previously received gamma knife radiosurgery (75 Gy) for MRCH with no morbidity, but no long-term improvement of pain relief (Patient 1 = 5 months, Patient 2 = 10 months) after treatment. For repeat radiosurgery, each patient received 75 Gy to the 100% isodose line delivered to the root entry zone of the trigeminal nerve, and was evaluated postretreatment. Pain relief was defined as: excellent (free of MRCH with minimal/no medications), good (50% reduction of MRCH severity/frequency with medications), fair (25% reduction), or poor (less than 25% reduction). RESULTS: Following repeat radiosurgery, long-term pain relief was poor in both patients. Neither patient sustained any immediate morbidity following radiosurgery. Patient 2 experienced right facial numbness 4 months postretreatment, while Patient 1 experienced no morbidity. CONCLUSION: Repeat radiosurgery of the trigeminal nerve fails to provide long-term pain relief for MRCH. Given the reported failures of initial and repeat radiosurgery for MRCH, trigeminal nerve radiosurgery should not be offered for MRCH.     

原发性三叉神经痛伽玛刀放射外科治疗的有效性评估

目的:评价伽玛刀放射外科治疗原发性三叉神经痛的安全性、有效性和心理状态。方法:2004年8月~2010年9月,98例经药物和其他方法治疗无效的原发性三叉神经痛患者接受伽玛刀放射外科治疗。放射剂量中位值是80 Gy(75~85 Gy)。采用患者自我报告疼痛的控制、生活满意度指数A(1ife satisfaction index A,LSI-A)的变化进行疗效评估。结果:治疗后89例(90.8%)患者获得随访,平均随访期35个月(13~60个月)。本组病例中治愈51例(57.3%);显效19例(21.3%);有效11例(12.4%);无效8例(9%),总有效率为91%;伽玛刀治疗后LSI-A总分平均值(36.25±3.87)高于治疗前(25.67±3.5);其中67例以往未接受过手术治疗患者中62例获得随访,58例有效,总有效率为93.5%。11例患者感觉患侧面部麻胀感,1例(二次治疗者)张口轻度受限。结论:伽玛刀放射外科治疗三叉神经痛显著缓解疼痛,提高生存质量。     

A prospective cost-effectiveness study of trigeminal neuralgia surgery

OBJECTIVES: Approximately 8000 patients with trigeminal neuralgia undergo surgery each year in the United States at an estimated cost exceeding $100 million. We compared 3 commonly performed surgeries (microvascular decompression, glycerol rhizotomy, and stereotactic radiosurgery) to evaluate the relative cost-effectiveness of these operations for patients with idiopathic trigeminal neuralgia. METHODS: Prospective nonrandomized trial at a tertiary referral center from July 1999 to December 2001. One hundred twenty-six consecutive patients underwent 153 operations (microvascular decompression, n=33; glycerol rhizotomy, n=51; stereotactic radiosurgery, n=69). Preoperative characteristics were similar between the groups with respect to sex, pain location, duration of pain, and atypical features. Facial pain outcomes were classified as excellent (no pain, no medications), good (no pain, reduced medications), fair (>50% pain reduction), and poor. The cost per quality adjusted pain-free year was compared between the groups. Mean follow-up was 20.6 months. RESULTS: Patients having microvascular decompression more commonly achieved and maintained an excellent outcome (85% and 78% at 6 and 24 months) compared with glycerol rhizotomy (61% and 55%, P=0.01) and stereotactic radiosurgery (60% and 52%, P<0.01). No difference was detected between glycerol rhizotomy and stereotactic radiosurgery (P=0.61). The cost per quality adjusted pain-free year was $6,342, $8,174, and $8,269 for glycerol rhizotomy, microvascular decompression, and stereotactic radiosurgery, respectively. Reduction in the average cost of morbidity and additional surgeries to zero did not make either microvascular decompression or stereotactic radiosurgery more cost-effective than glycerol rhizotomy. Both microvascular decompression and stereotactic radiosurgery would be more cost-effective than glycerol rhizotomy if the cost of additional surgeries after glycerol rhizotomy increased 79% and 83%, respectively. DISCUSSION: This analysis supports the practice of percutaneous surgeries for older patients with medically unresponsive trigeminal neuralgia. At longer follow-up intervals, microvascular decompression is predicted to be the most cost-effective surgery and should be considered the preferred operation for patients if their risk for general anesthesia is acceptable. More data are needed to assess the role that radiosurgery should play in the management of patients with trigeminal neuralgia.     

Stereotactic radiosurgery for the treatment of trigeminal neuralgia.

Stereotactic radiosurgery is an increasingly used and the least invasive surgical option for patients with medically refractory trigeminal neuralgia (TN). The authors began use of this technique at our center in 1992 and have evaluated outcomes serially. Independently acquired data from 220 patients with idiopathic TN that had Gamma Knife radiosurgery was reviewed. The median radiosurgery dose was 80 Gy with a range of 60 to 90 Gy. Most patients had features of typical TN, although 16 (7.3%) described additional atypical features. One hundred thirty-five patients (61.4%) had prior surgery. Patients were followed to a maximum of 6.5 years (median, 2 years). Complete or partial pain relief was achieved in 85.6% of patients at 1 year. Complete pain relief was achieved in 64.9 % of patients at 6 months, 70.3% at 1 year, and 75.4% patients at 33 months. Patients with an atypical pain component had a lower rate of achieving pain relief ( p = 0.025). Due to recurrences, 55.8% of patients had complete or partial pain relief at 5 years. The absence of preoperative sensory disturbance or prior surgery correlated with an increased proportion of patients in complete or partial pain relief over time. Ten percent of patients developed new or increased subjective facial paresthesia or facial numbness. Radiosurgery for idiopathic TN was safe and effective, and provided benefit to a patient population with a high frequency of prior surgical intervention. It is an important addition to the surgical armamentarium for TN.     

伽玛刀治疗三叉神经痛疼痛缓解时间分析

目的分析和总结采用双靶点伽玛刀治疗三叉神经痛术后疼痛缓解时间规律,为伽玛刀的临床治疗提供参考。方法 2005年1月-2011年1月,共147例原发性三叉神经痛患者于四川大学华西医院接受Leksell C型伽玛刀治疗。使用4 mm准直器在三叉神经根制作2个等中心靶点,中心剂量80～90 Gy,控制脑桥照射剂量<20 Gy。术后定期对患者进行随访,对疼痛缓解时间进行统计分析。结果 130例患者获得随访,随访时间11～64个月,平均28.7个月。术后疼痛完全缓解95例(73.1%),部分缓解29例(22.3%),无效6例(4.6%)。疼痛缓解时间4 h～12个月,平均3.6周,其中疼痛完全缓解患者的疼痛缓解时间明显短于部分缓解患者(P<0.05)。53例(40.8%)患者于术后出现术侧轻度面部麻木。结论患者术后疼痛缓解时间可能是预测伽玛刀治疗效果的重要因素,但疼痛缓解时间个体差异大,应进行长期随访观察。     

Studies on the operative outcomes and mechanisms of microvascular decompression in treating typical and atypical trigeminal neuralgia

OBJECTIVE: To evaluate the operative outcomes and mechanisms of microvascular decompression in treating typical and atypical trigeminal neuralgia. METHODS: A group of 45 patients with typical trigeminal neuralgia and 17 patients with atypical trigeminal neuralgia treated by micro-vascular decompression from 2000 to 2002 were reviewed, including their clinical presentations, operative findings, and outcomes. RESULTS: Of 45 patients with typical trigeminal neuralgia, the mean duration was 3.1 years, and the mean age of pain onset was 60.3 years. Single trigeminal division was involved in 20 patients (44.4%), and 2 or 3 divisions were involved in the other 25 patients (55.6%). During the operation, artery compression was found in 39 patients (86.7%), and the combined artery and venous compression was found in 6 patients (13.3%). Postoperatively, complete pain relief was achieved in 44 patients (97.8%), and significant pain relief was achieved in 1 patient (2.2%). As for 17 patients with atypical trigeminal neuralgia, the mean duration and the mean age of pain onset was 8.7 years and 55.5 years, respectively. Two or 3 trigeminal divisions were involved in all of these patients. During operation, artery compression occurred in 10 patients (58.8%), and the combined artery and venous compression was found in 7 patients (41.2%). Postoperatively, complete pain relief was achieved in 5 patients (29.4%), and partial pain relief was achieved in 10 patients (58.8%), and 2 patients showed no response to microvascular decompression. CONCLUSIONS: The operative outcome of microvascular decompression in patients with typical trigeminal neuralgia was better than that of patients with atypical trigeminal neuralgia, which perhaps related to short duration, late onset of pain, limited distribution, artery compression, and complete operative decompression.     

Gamma Knife Stereotactic Radiosurgery in the Management of Cluster Headache

Gamma knife stereotactic radiosurgery (SRS) has proven to be an effective management approach for trigeminal neuralgia and as a minimally invasive alternative management option for cluster headache (CH). In CH, patients undergo single-session focused irradiation of the trigeminal nerve root (TN), sometimes coupled with irradiation of the sphenopalatine ganglion (SPG) as well. SRS provides early pain relief in most patients, but is associated with trigeminal sensory dysfunction in some patients. In the future, a prospective trial that compares a single target of TN to dual targets of both the TN and SPG may provide further understanding of the value of SRS for CH.     

三叉神经痛的外科治疗 : 经皮治疗或微血管减压治疗结果分析

目的比较当代治疗三叉神经痛3种外科方法的疗效。方法采用相同原则,对483例原发性三叉神经痛患者用3种不同外科方法治疗的临床效果进行分析。结果采用微血管减压(MVD)治疗155例,出院时分析获疼痛完全缓解76.1%,部分缓解19.3%,无效4.5%;平均随访52.5个月,疼痛完全缓解58.5%,部分缓解27.3%,无效14.1%。采用射频热凝(TCG)治疗113例,出院时疼痛完全缓解61.9%,部分缓解25.6%,无效12.5%;平均随访45.4个月,疼痛完全缓解2.2%,部分缓解33.7%。采用经皮球囊压迫(PMC)治疗215例,出院时疼痛完全缓解67.4%,部分缓解21.4%,无效11.2%;平均随访38.3个月,疼痛完全缓解13.6%,部分缓解29.2%,无效57.1%。结论MVD最有效,尽管PMC在治疗上也起很大作用,但应作为MVD的一种替换手段。