Leksell伽玛刀治疗原发性三叉神经痛46例报告

目的 评估伽玛刀在治疗原发性三叉神经痛中的作用与地位。方法 用1．5Tesla MRI行三堆超薄立体定位快速扫描。对46例原发性三叉神经痛病人行LEKSELL伽玛刀放射手术治疗，4mm准直器，中心刺量70～90Gy。靶点设定为三叉神经感觉根入桥脑处。结果 用标准咨询法对病人进行疗效评估。放射手术治疗前后疼痛按Ⅰ～Ⅳ级评分。Ⅰ级：无痛；Ⅱ级：偶发疼痛。不需用药；Ⅲ级。轻度疼痛。服药能控制；Ⅳ级。疼痛不能用药控制。46例病人中Ⅰ级26例(56．5％)。Ⅱ级9例(19．5％)。Ⅲ级7例(15．2％)。Ⅳ级4例(8．6％)。此外有4例病人疼痛复发。并接受第二次伽玛刀手术治疗。症状完全缓解。3例病人(6．5％)有迟发性的面部感觉丧失。无其他并发症发生。结论 伽玛刀放射外科手术是一种安全有效治疗三叉神经痛的高科技方法。应用性强。我们认为只要诊断成立。就可考虑施行伽玛刀手术治疗。

Gamma Knife Treatment for Primary Trigeminal Neuralgia

Objective To evaluate the role of Gamma Knife radiosurgery (RS) in the management ofmedically refractory trigeminal neuralgia (TN). Methods 46 cases with primary trigeminal neuralgiatreated by gamma knife using MRfor stereotactic localization. The 4mm secondary collimator helmet anda radiosurgical dose maximum of 70～90Gy were used. The isocenter was placed at the trigeminal senso-ry root adjacent to the pons identified on stereotactic MRI scans. Realts Outcome was evaluated usinga standardized questionnaire. Pain before and after RS was scored as level Ⅰ-Ⅳ (Ⅰ: no pain; Ⅱ: occa-sional pain, not requiring medication; Ⅲ: some pain, controlled with medication; Ⅳ: some pain, notcontrolled with medication). Among our 46 TN patients, 26(56. 5%) experienced pain relief, Ⅱ in 9(19. 5%), Ⅲ in 7(15.2%) , and Ⅳ in 4 (8.6%). 4 cases recurred that received the second time ofgamma knife treatment, and all of them have a good effect. 3 patients (6.5%) developed delayed loss offacial sensation following treatment, but no other complications were noted. Conclusions We believethat Gamma Knife radiosurgery is one of the safest and most effective treatments which are currentlyavailable for trigeminal neuralgia. We recommend early radiosurgical treatmentfor trigeminal neuralgiaonce the diagnosis is clearly established.