三叉神经痛的立体定向放射治疗

背景在三叉神经痛的治疗中,传统的方法有药物、封闭、手术等.而立体定向放射治疗三叉神经痛具有无创伤、无痛苦、疗效显著等优点,对这种方法的研究国内外刚刚起步.目的探讨立体定向放射治疗对三叉神经疼痛症状的改善效应.设计以患者为观察对象的病例分析.单位河南科技大学第一附属医院X刀治疗中心.对象选择1999-03/2002-03河南科技大学第一附属医院X刀治疗中心收治的三叉神经痛患者30例,均经临床诊断和CT或MRI证实,无其他疾病引起,经长期药物或手术治疗效果不佳的患者为研究对象.方法对30例三叉神经痛患者实施头戴面罩,单次、非共面、多角度的立体定向放射治疗.靶点数2个,准直器5mm,边周剂量60～75 Gy,参考剂量曲线85%～90%.主要观察指标疗效评定结果和随访结果.结果对30例患者均实施随访,随访1～22个月,12～24h症状减轻或缓解者6例,1～3个月显效者20例,4例效果不明显,有效率达87%.1例出现患侧面部麻木,1例首次治疗效果不佳,再次调整剂量后效果显著.结论立体定向放射治疗三叉神经痛效果肯定,无特殊副反应.

Stereotacticradiotherapy for trigeminal neuralgia

BACKGROUND: There are several ways for treating the trigeminal neuralgia, such as medication, block therapy and surgery, etc. But few reports throughout the world described stereotactic radiotherapy(SRT) for it, which is efficient, non-invasive and painless.OBJECTIVE: To investigate the improvement of SRT for trigeminal neuralgia.DESIGN: Case analysis based on patients.SETTING: X-knife Treatment Center, First Affiliated Hospital, Henan University of Science and Technology.PARTICIPANTS: Totally 30 patients with trigeminal neuralgia were selected from X-knife Treatment Center, the First Affiliated Hospital of Henan Science and Technology University between March 1999 and March 2002. All patients were diagnosed with CT or MRI, and no other diseases were found. Patients without obvious effect from a long-term medicine treatment or surgery were selected as the investigative subjects.METHODS: Thirty patients with trigeminal neuralgia wearing face cover were treated with non-coplanarity fractional stereotactic radiotherapy. The patients received 2 target regions and peripheral does of 60 - 75 Gy. 5 mm collimator and isodose curves referred to ranged from 85% - 90%.MAIN OUTCOME MEASURES: Results of therapeutic assessment and follow up.RESULTS: The follow up period ranged from 1 to 22 months. Among 30patients, 6 patients' symptoms were lightened or eased up over 12-24hours, 20 patients received a marked effect over 1 - 3 months, 4 patients'treatment effects were not obvious. The effect rate reached 87%. A patient occurred numbness in sick face, and a patient showed no obvious effect in the first treatment, but the efficacy became evident in the second treatment.CONCLUSION: It is efficient in the treatment of trigeminal neuralgia with stereotaetic radiotherapy and there is no special side effect.