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目的通过对二次伽玛刀治疗原发性三叉神经痛病例的长期随访,评价治疗的安全性,有效性及并发症发生情况。方法 1998年4月～2009年9月,54例经伽玛刀治疗后无效或复发的原发性三叉神经痛患者接受二次伽玛刀放射外科治疗。初次治疗中心放射剂量平均为80.9Gy(70～90Gy),二次治疗放射剂量平均为74.8Gy(70～80Gy)。结果 23例患者(42.6%)完成了随访,疼痛复发时间平均18个月(6～78个月)。二次治疗后疼痛完全缓解者17例(74.0%);疼痛缓解程度>50%,服用药物减量>50%者3例(13.0%);疼痛缓解程度<50%或无效者3例(13.0%),总有效率87.0%。疼痛缓解出现平均时间为10周(1～16周)。面部麻木,感觉异常的发生率为18例(78%),7例(30.4%)患者出现咬肌无力。结论二次伽玛刀治疗原发性三叉神经痛安全有效,但并发症的发生率明显增高。
Objective To evaluate the safety, efficacy and complications of secondary gamma knife in the treatment of primary trigeminal neuralgia patients. Methods From April 1998 to September 2009, 54 patients with primary trigeminal neuralgia who were ineffective or relapsed after gamma knife treatment were treated with gamma knife radiosurgery. The primary treatment center radiation dose averaged 80.9Gy (70 ~ 90Gy), the second treatment radiation dose average 74.8Gy (70 ~ 80Gy). Results Twenty-three patients (42.6%) were followed up for an average of 18 months (range, 6 to 78 months) of pain recurrence. Seven patients (74.0%) had complete pain relief after secondary treatment; pain relief was> 50%; three patients (13.0%) took medication reduction> 50%; three patients (13.0% %), The total effective rate of 87.0%. Pain relief averaged 10 weeks (1 to 16 weeks). The incidence of facial numbness and sensory abnormalities was 18 cases (78%), and masseter weakness was found in 7 cases (30.4%). Conclusion Secondary gamma knife treatment of primary trigeminal neuralgia is safe and effective, but the incidence of complications was significantly higher.