伽玛刀治疗原发性三叉神经痛的临床研究

目的探讨伽玛刀(γ刀)立体定向放射外科治疗原发性三叉神经痛(trigeminal neuralgia,TN)的方法和疗效。方法对49例TN患者采用磁共振扫描、Gamma 2TPS系统定位、剂量规划后,采用OUR-XGDγ刀行三叉神经痛立体定向放射外科治疗。治疗靶点位于三叉神经根近脑干侧,其中44例采用双4 mm准直器,另外5例采用单4 mm准直器,放射中心剂量为60~80 Gy,平均(71.7±9.3)Gy。结果经3~36月随访观察,平均(26.0±7.3)月。依据Brisman三叉神经疼痛治疗的判定标准:治愈28例(57.1%),显效11例(22.4%),有效7例(14.3%),无效3例(6.1%),总有效率达93.9%,未见明显不良反应。结论γ刀治疗TN总体安全有效,适用于临床推广。

Evaluation on Gamma Knife Radiosurgery in the Treatment of Trigeminal Neuralgia

Objective To investigate the methods and efficacy of gamma knife （γ- knife） stereotactic radiosurgery for trigeminal neuralgia （TN）. Methods 49 patients suffered from TN were scanned by magnetic resonance imaging, located lesions by Gamma 2TPS system and got dosage planed according to the position and the disease courses before treatment. OUR-XGD γ-knife was used for stereotactic radiosurgery. Therapeutic target was located near the root of brainstem trigeminal. 44 cases were treated with double 4mm collimator, another 5 cases were used single 4mm collimator. The center doses of radiation were 60 ～ 80 Gy, meanly （71.7 ± 9.3 ） Gy. Results Follow-up varied from 3 to 36 months, meanly （ 26.0 ± 7.3 ） months. There were 28.cases （57.1%） cured, 11 cases （22.4%） improved, 7 cases （14.3%） efficacy, and 3 cases （6.1%） invalid. The total effective rate was 93.9%, without significant adverse effect. Conclusion It is safe and effective to treat TN usin γ-knife. which could be applied to clinical practice.