伽玛刀治疗原发性三叉神经痛的临床疗效及影响因素分析

摘要

Objective:To analyze the treatment results and prognostic factors of stereotactic gamma knife radiosurgery for trigeminal neuralgia. Methods:56 cases of 2002 January~2012 year in December were treated by conservative treatment ineffective drugs in patients with primary trigeminal neuralgia were treated by gamma knife treatment,through visits or telephone follow-up evaluation of gamma knife.On mayaffect the efficacy of factors, including whether the images suggest thatthe vascular compression of the trigeminal nerve root and other facialdecreased sensation and the gender and age,course of disease before operation, preoperative, dose, single factor analysis. Results:follow up for 6~58 months. During the follow-up period, the total effective rate was 92.9%(52/56),root according to BNI pain scale, the grade I in 29 cases,17 cases of grade II, 6 cases of grade III,IV in 4 cases.The incidence of complications was 10.7%(6/56), including the treatment of facialnumbness in 5 cases, 1 cases of myasthenia gravis were chewing, does not affect the normal life. The statistical results show that, on the prognosis, only whether preoperative imaging suggested the vascular compression of the trigeminal nerve root was statistically significant(P=0.000). Conclusion: gamma knife in the treatment of primary trigeminal neuralgia with high security, good treatment effect, minimally invasive and other advantages, is worthy of wide application and promotion in primary trigeminal neuralgia patients with simple drug treatment is invalid in theprocess.With or without preoperative vascular compression of the trigeminal nerve root, is an important prognostic factor.%目的：分析伽玛刀放射外科治疗原发性三叉神经痛的疗效及预后因素。方法采用伽玛刀对2002年1月—2012年12月收治的56例经药物等保守治疗无效的原发性三叉神经痛患者进行治疗，通过复诊或电话随访评价伽玛刀治疗效果。对可能影响疗效的因素，包括年龄、性别、病程、剂量、术前是否面部感觉减弱以及术前是否影像提示血管压迫三叉神经根等，进行单因素分析分析。结果本组随访6~58个月。随访期内总有效率92.9%(52/56)，根照BNI疼痛量表，其中Ⅰ级29例，Ⅱ级17例，Ⅲ级6例，Ⅳ级4例。并发症发生率10.7%(6/56)，包括治疗侧面部麻木5例、咀嚼肌无力1例，均不影响正常生活。统计结果表明，对预后而言，仅术前是否影像提示血管压迫三叉神经根有统计学意义(P=0.000)。结论伽玛刀治疗原发性三叉神经痛具有安全性高、治疗效果好、微创等优势，值得在单纯药物无效的原发性三叉神经痛患者的治疗过程中广泛应用和推广。术前有无血管压迫三叉神经根，是重要的预后因素。