三叉神经痛的伽玛刀与显微外科治疗

目的 探讨原发性三叉神经痛(ITN)和继发性三叉神经痛(STN)的治疗方法及效果.方法 2001年1月至2006年5月在我科接受治疗的145例三叉神经痛患者,其中ITN 98例,STN 47例.伽玛刀治疗81例,其中ITN 68例,STN 13例(继发于脑膜瘤1例,三叉神经瘤12例).开颅手术治疗64例,其中ITN 30例(行微血管减压11例,三叉神经感觉根切断19例);STN 34例(继发于胆脂瘤20例,三叉神经瘤14例).结果 ITN伽玛刀治疗的有效率为94.1%(64/68),完全无痛为52.9%(36/68);STN的有效率为46.2%(6/13),完全无痛为23.1%(3/13).肿瘤控制率为923%(12/13),ITN的微血管减压无痛率为100%(11/11),三叉神经感觉根切断无痛率为100%(19/19).STN肿瘤切除后无痛率为100%(34/34).开颅手术者并发颅内感染2例.5年随访,伽玛刀治疗的ITN的复发率为7.8%(5/64),STN的复发率为66.7%(4/6);微血管减压的复发率为9.1%(1/11),三叉神经感觉根切断的复发率为10.5%(2/19).结论 ITN的伽玛刀治疗有效率高,并发症少,安全性好;微血管减压和三叉神经感觉根切断的有效率更高,但并发症发生率较高.对于STN,我们建议行开颅手术切除肿瘤为首选方法.

Treatment of Trigeminal Neuralgia with Gamma Knife and Microneurosurgery

Objective To explore the method to the treat trigeminal neuralgia(TN). Methods Of 145 patients with trigeminal neuralgia treated in our department from January 2001 to May 2006, 98 suffered from idiopathic trigeminal neuralgia (ITN), and 47 from secondary trigeminal neuralgia(STN). Of 81 patients underwent the Gamma Knife treatment, 68 suffered from ITN and 13 from STN (1 case of TN secondary to Meningeoma and, 12 to trigeminal neurofibroma). The retromastoid craniotomy were performed in 64 patients, of whom, 30 suffered from ITN (11 patients underwent microvascular decompression and 19 retrogasserian neurotomy) and 34 from STN (20 suffered from pearl tumor and 14 from trigeminal neurofibroma). Results The effective rate of the ITN treated by Gamma Knife was 94.1%(64/68), and among them 52.9%(36/68) reached complete analgesia. After the treatment with Gamma knife 46.2%(6/13) of patients with STN had the pain relief, among them 23.1% (3/13) reached completed analgesia and the rate of tumor control was 92.3%(12/13). After the microvascular decompressinon, all of 11 patients with ITN had no pain and the same result appeared in 19 patients who underwent the trigeminal neurotomy. All of 34 patients with STN had no pain after the tumor resection. There was intracranial infection in 2 patients after the craniotomy. During following-up for 5 years, the recurrent rate in the patients with ITN treated by Gamma Knife was 7.8%(5/64), and in ones with STN was 66.7%(4/6); the recurrent rate in ones with ITN treated by microvascular decompression was 9.1%(1/11), and in ones with ITN treated by neurotomy was 10.5%(2/19). Conclusion The treatment of ITN with Gamma Knife is very effective and safe, and does not cause any severe complications. Although the microvascular decompression and neurotomy can produce analgesia immediately after the operations, it may cause relatively more complications. The total resection of the tumor should be first selected in the patient with TN secondary to tumor.