Comparison of posterior fossa exploration and stereotactic radiosurgery in patients with previously nonsurgically treated idiopathic trigeminal neuralgia.
Comparison of posterior fossa exploration and stereotactic radiosurgery in patients with previously nonsurgically treated idiopathic trigeminal neuralgia.
复制标题
后颅窝探查和立体定向放射外科治疗先前非手术治疗的特发性三叉神经痛患者的比较。
DOI：
10.3171/foc.2005.18.5.7
复制
发表时间：
2005
影响因子：
4.1
通讯作者：
B. Pollock
中科院分区：
文献类型：
--
作者：
B. Pollock
对象
立体定向放射外科手术(SRS)通常用于三叉神经痛患者，许多研究人员发现，对于先前手术未失败的患者，该手术后面部疼痛的结果更好。一些中心的研究人员声称，SRS的结果相当于后颅窝探查(PFE)。这项研究的目标是验证这一说法。
方法
信息从预期维护的数据库中检索，该数据库记录了1999年至2004年间接受PFE(55名患者)或SRS(28名患者)作为初次手术的70岁以下的特发性三叉神经痛患者。在两组患者中，接受放射外科治疗的患者年龄较大(60.5岁比50.7岁，p<；0.001)。PFE组微血管减压术49例(89%)，部分神经切断术6例(11%)。SRS的平均最大剂量为89.1Gy.在平均25.5个月的随访期中，接受PFE治疗的患者在没有药物治疗的情况下通常没有疼痛(1年为75%，3年为72%)，而接受SRS治疗的患者(1年和3年为59%；p=0.01)。PFE后有10名患者(18%)接受了额外的手术，而SRS后有8名患者(29%)接受了额外的手术(p=0.4)。PFE术后8例(15%)出现新的面部麻木(6例)或感觉障碍(2例)，SRS后12例(43%)出现新的面部麻木(8例)或感觉障碍(4例)。PFE后面部麻木的发展与面部疼痛的结果之间没有相关性(p=0.37)，而放射外科手术后出现三叉神经功能障碍的患者更容易摆脱疼痛(p=0.02)。
结论
结果表明，对于特发性三叉神经痛患者，PFE是一种比SRS更有效的初级手术。此外，在PFE过程中，三叉神经损伤并不是获得良好的面部疼痛结果的必要条件。
OBJECT
Stereotactic radiosurgery (SRS) is commonly performed in patients with trigeminal neuralgia, and numerous investigators have found that facial pain outcomes after this procedure are better for patients in whom prior surgery did not fail. Researchers in some centers claim that the results of SRS are equivalent to posterior fossa exploration (PFE). The goal in this study was to verify that claim.
METHODS
Information was retrieved from a prospectively maintained database of patients less than 70 years old with idiopathic trigeminal neuralgia who underwent PFE (55 patients) or SRS (28 patients) as their initial surgery between 1999 and 2004. Of the two groups, patients who underwent radiosurgery were older (60.5 compared with 50.7 years, p<0.001). Microvascular decompression was performed in 49 patients (89%) and partial nerve section was performed in six (11%) in the PFE group. The mean maximum dose for SRS was 89.1 Gy. At a mean follow-up duration of 25.5 months, patients who had undergone PFE were more commonly pain free without medications (75% at 1 year, 72% at 3 years) compared with the patients treated with SRS (59% at 1 and 3 years; p = 0.01). Additional surgery was performed in 10 patients (18%) after PFE, compared with eight patients (29%) after SRS (p = 0.4). Eight patients (15%) had either new facial numbness (six cases) or dysesthesias (two cases) after PFE, whereas 12 (43%) had either new facial numbness (eight cases) or dysesthesias (four cases) after SRS. No correlation was noted between the development of facial numbness and facial pain outcome after PFE (p = 0.37), whereas patients in whom trigeminal dysfunction developed after radiosurgery were more frequently free of pain (p = 0.02).
CONCLUSIONS
The results support PFE as a more effective primary surgery than SRS in patients with idiopathic trigeminal neuralgia. Moreover, injury to the trigeminal nerve during PFE is not required to achieve excellent facial pain outcomes.
影响因子：
4.1
作者：
BURCHIEL, KJ;CLARKE, H;LOESER, JD
通讯作者：
LOESER, JD
影响因子：
4.1
作者：
Menzel, M;Doppenberg, EMR;Bullock, R
通讯作者：
Bullock, R