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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 1.5TeslaMRI行三维超薄立体定位快速扫描 ,对 4 6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 ,中心剂量 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。 4 6例病人中Ⅰ级 2 6例(5 6 .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。
Objective To evaluate the role and position of gamma knife in the treatment of primary trigeminal neuralgia. Methods Three-dimensional ultra-thin stereotactic rapid scanning was performed with 1.5 Tesla MRI. LEKSELL gamma knife radiosurgery was performed on 46 patients with primary trigeminal neuralgia. The 4-mm collimator was used and the central dose was 70-90 Gy. Targeted as the trigeminal nerve root into the bridge pons. Results The patients were evaluated by standard consultation method. The pains before and after radiotherapy were graded according to grade Ⅰ ~ Ⅳ, grade Ⅰ: painless, grade Ⅱ: occasional pain without medication, grade Ⅲ: mild pain, medication could be controlled, Grade IV: Pain can not be controlled by medication. There were 26 patients (46.5%) in grade I, 9 (19.5%) in grade II, 7 (15.2%) in grade 3 and 4 (8.6%) in grade IV in addition to 4 Patients with recurrent pain, and received a second gamma knife surgery, symptoms were completely relieved, 3 patients (6.5%) had delayed facial sensation loss, no other complications. Conclusion Gamma knife radiosurgery is a high-tech method for the safe and effective treatment of trigeminal neuralgia. It has strong applicability. We think that gamma knife surgery can be considered as long as the diagnosis is established.