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。

Study of the Pain Relief Time of Gamma Knife Radiosurgery for Idiopathic Trigeminal Neuralgia

Objective To analyze the characteristics of the pain relief time of gamma knife radiosurgery(GKR) for idiopathic trigeminal neuralgia.Methods From January 2005 to January 2011,147 patients underwent GKR at our center.Among them,93 were males and 54 were females with the mean age of 67.9 years(ranged from 51 to 83 years).MR images of turbo spin echo and constructive interference in steady state sequences were fused for preoperational location.The maximum central dose of 80-90 Gy was delivered to the trigeminal nerve root with two isocenters via a 4-mm collimator helmet.And the plug pattern was used to limit the dose to the pons to be under 20 Gy.The patients were followed up by periodical phone call or personal interview.Results A total of 130 patients finished the follow-up.The mean follow-up time was 28.7 months (ranged from 5 to 64 months).The number of patients with complete,partial pain remission and no effect were 95(73.1%),29(22.3%),and 6(4.6%).The average time before complete pain relief was 3.6 weeks(ranged from 4 hours to 12 months).Recurrence occurred in 3 patients 26-53 months after the treatments.Fifty-three patients(40.8%) experienced tolerable facial numbness among which 29 were self-relieved.Paroxysmal temporalis muscle spasm occurred in one patient during 2-6 weeks after the treatment and was self-relieved.No other complications occurred.Conclusions The pain relief time is corresponding with the long-term outcome of GKR treatment.However,a long-term follow-up was suggested to investigate the effect of the treatment since the pain relief time varied in different patients.