原发性三叉神经痛伽玛刀治疗（附838例分析）

摘要

目的：评价伽玛刀治疗原发性三叉神经痛的疗效及相关因素。方法采用1.5T核磁共振影像,Gamma-TPS治疗计划系统,OUR伽玛刀治疗原发性三叉神经痛838例,治疗靶点在三叉神经感觉根进入桥脑处( REZ区),用4mm准直器,中心最大剂量70~90Gray。以50%等剂量曲线覆盖靶点,脑干边缘剂量为15~16Gy。结果586例随访3~48个月,疼痛完全缓解410例(70%)；疼痛基本消失(缓解>80%)59例(10%)；疼痛缓解>50%有83例(14.2%)；无效34例(5.8%),总有效率为94.2%。23例(3.9%)出现一过性轻度面部麻木、感觉减退,无其他并发症。结论伽玛刀治疗原发性三叉神经痛疗效显著、安全,是一种理想的治疗方法。%Objective To evaluate the efficacy of gamma knife in the treatment of primary trigeminal neuralgia and its re-lated factors. Methods We use 1. 5T magnetic resonance imaging,Gamma-TPS treatment planning system treated 838 cases of primary trigeminal neuralgia. The therapeutic targets were at the zone where the sensory root of the trigeminal nerve enters pons ( REZ) ,and with 4 mm collimator,the maximum central dose was 70~90 Gray. We cover the targets with 50% isodose curve and the dose at brainstem margin was 15~16Gy. Results 586 cases were followed up for 3 to 48 months,among which there were 410 patients(70%)with complete pain relief(70%),59 patients(10%)whose pain basically disappeared(relieved more than 80%),83 patients(14. 2%)whose pain relieved more than 50% and 34 patients(5. 8%)receiving no effect. The total effective rate was 94. 2%,while 23 petients(3. 9%)had transient mild facial numbness and hypoesthesia,but no other complications. Con-clusion Gamma knife,in the treatment of primary trigeminal neuralgia,is significant and safe as an ideal therapeutic method.