Stereotactic radiosurgery for trigeminal neuralgia: A multiinstitutional study using the gamma unit
Stereotactic radiosurgery for trigeminal neuralgia: A multiinstitutional study using the gamma unit
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DOI：
10.3171/jns.1996.84.6.0940
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发表时间：
1996-06-01
影响因子：
4.1
通讯作者：
Lindquist, C
中科院分区：
文献类型：
--
作者：
Kondziolka, D;Lunsford, LD;Lindquist, C
一项多机构研究旨在评价伽玛刀立体定向放射外科治疗三叉神经痛的技术、剂量选择参数和结果。来自5个中心的50名患者接受了放射外科手术，使用单个4 mm等中心点瞄准神经根进入区。32例患者既往接受过手术，平均手术次数为2.8（范围1-7）。本研究中使用的放射外科治疗的目标剂量范围为60 - 90 Cy。放射外科手术后的中位随访期为18个月（范围11-36个月）。29名患者（58%）控制良好（无疼痛），18名（36%）控制良好（缓解50%-90%），3名（6%）治疗失败。至疼痛缓解的中位时间为1个月（范围1天-6.7个月）。除3例（6%）患者在术后5、7和10个月疼痛复发外，所有病例的反应在术后3年内保持一致。在2年时，54%的患者疼痛消失，88%的患者疼痛缓解50%至100%，最大放射外科剂量为70戈伊或更高与疼痛完全缓解的机会显著增加相关（72% vs. 9%，p = 0.0003）。3名患者（6%）在放射手术后出现面部感觉异常增加，其中1例完全消退，另1例改善。没有患者出现其他缺陷或传入神经阻滞疼痛。近端三叉神经和根进入区，这是明确的磁共振成像，是一个适当的解剖目标放射外科。放射外科使用伽玛单位是一个额外的有效的外科方法，为管理医疗或手术难治性三叉神经痛。需要进行长期的后续审查。
A multiinstitutional study was conducted to evaluate the technique, dose-selection parameters, and results of gamma knife stereotactic radiosurgery in the management of trigeminal neuralgia. Fifty patients at five centers underwent radiosurgery performed with a single 4-mm isocenter targeted at the nerve root entry zone. Thirty-two patients had undergone prior surgery, and the mean number of procedures that had been performed was 2.8 (range 1-7). The target dose of the radiosurgery used in the current study varied from 60 to 90 Cy. The median follow-up period after radiosurgery was 18 months (range 11-36 months). Twenty-nine patients (58%) responded with excellent control (pain free), 18 (36%) obtained good control (50%-90% relief), and three (6%) experienced treatment failure. The median time to pain relief was 1 month (range 1 day-6.7 months). Responses remained consistent for up to 3 years postradiosurgery in all cases except three (6%) in which the patients had pain recurrence at 5, 7, and 10 months. At 2 years, 54% of patients were pain free and 88% had 50% to 100% relief.A maximum radiosurgical dose of 70 Gy or greater was associated with a significantly greater chance of complete pain relief (72% vs. 9%, p = 0.0003). Three patients (6%) developed increased facial paresthesia after radiosugery, which resolved totally in one case and improved in another. No patient developed other deficits or deafferentation pain. The proximal trigeminal nerve and root entry zone, which is well defined on magnetic resonance imaging, is an appropriate anatomical target for radiosurgery. Radiosurgery using the gamma unit is an additional effective surgical approach for the management of medically or surgically refractory trigeminal neuralgia. A longer-term follow-up review is warranted.