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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。
Objective To analyze and summarize the time of pain relief after trigeminal neuralgia treated by dual target gamma knife, and provide a reference for the clinical treatment of gamma knife. Methods From January 2005 to January 2011, 147 patients with primary trigeminal neuralgia underwent Leksell type C gamma knife treatment at West China Hospital of Sichuan University. A 4 mm collimator was used to make 2 isocenters in the trigeminal nerve root. The central dose was 80-90 Gy and the pontine dose was controlled at <20 Gy. Regular follow-up of patients after surgery, pain relief time for statistical analysis. Results 130 patients were followed up for 11 ~ 64 months with an average of 28.7 months. Postoperative pain was relieved completely in 95 cases (73.1%), partially relieved in 29 cases (22.3%) and ineffective in 6 cases (4.6%). The pain relief time ranged from 4 h to 12 months, with an average of 3.6 weeks. Pain relief time was significantly shorter in patients with complete pain relief than in partially relieved patients (P <0.05). Fifty-three patients (40.8%) had slight facial numbness after operation. Conclusion The postoperative pain relief time may be an important factor in predicting the therapeutic effect of gamma knife. However, individual differences in pain relief time should be followed and long-term follow-up should be performed.