CAJ | 학술논문

目的探讨重复伽玛刀治疗原发性三叉神经痛(TN)的可行性、相关标准、疗效.方法选择自1995年1月至2006年2月接受初次伽玛刀(GK1)治疗的277例TN患者.靶点选择三叉神经感觉根近桥脑处,中心剂量为70～80 Gy;对其中23例无效和15例复发者行第二次伽玛刀(GK2)治疗,中心剂最为65～80 Gy,50%等剂量线限定靶点,33例仍将三叉神经感觉根近桥脑处作为靶点,5例采用双靶点治疗.结果 (1)GK2治疗后疼痛缓解时间:GK2治疗后所有患者均得到满意的电话随访,随访时间为12～108个月(平均55个月),出现疼痛缓解时间为1～180 d(平均120d).(2)治疗有效率:GK1治疗后有效率为91.7%(254/277);GK2治疗后为84.2%(32/38),其中GK1治疗后23例无效者和15例复发者治疗有效率分别为73.9%(17/23)和100%(15/15),两组差异有统计学意义(P=0.045).(3)并发症:GK1治疗后发生面部麻木或麻痹30例(10.8%),GK2治疗后新发生8例,新并发症的发生率为21.1%.结论伽玛刀是治疗TN安全有效的方法,严重副反应少.初次治疗后无效或复发者再次行伽玛刀治疗仍然有效,且复发者效果好于无效者.
목적 탐토중복가마도치료원발성삼차신경통(TN)적가행성、상관표준、료효.방법 선택자1995년1월지2006년2월접수초차가마도(GK1)치료적277례TN환자.파점선택삼차신경감각근근교뇌처,중심제량위70～80 Gy;대기중23례무효화15례복발자행제이차가마도(GK2)치료,중심제최위65～80 Gy,50%등제량선한정파점,33례잉장삼차신경감각근근교뇌처작위파점,5례채용쌍파점치료.결과 (1)GK2치료후동통완해시간:GK2치료후소유환자균득도만의적전화수방,수방시간위12～108개월(평균55개월),출현동통완해시간위1～180 d(평균120d).(2)치료유효솔:GK1치료후유효솔위91.7%(254/277);GK2치료후위84.2%(32/38),기중GK1치료후23례무효자화15례복발자치료유효솔분별위73.9%(17/23)화100%(15/15),량조차이유통계학의의(P=0.045).(3)병발증:GK1치료후발생면부마목혹마비30례(10.8%),GK2치료후신발생8례,신병발증적발생솔위21.1%.결론 가마도시치료TN안전유효적방법,엄중부반응소.초차치료후무효혹복발자재차행가마도치료잉연유효,차복발자효과호우무효자.
Objective To assess the feasibility, indications and therapeutic effect of repeatgamma knife radiosurgery for treatment of primary trigeminai neuralgia. Methods From January 1995to February 2006, 277 patients with primary trigeminal neuralgia underwent stereotactic radiosurgerytargeting the cistemal trigeminal nerve with a maximal central dose of 70-80 Gy. A second gamma kniferadiosurgery with a maximal central dose of 65-80 Gy was performed in 23 patients with refractory and15 with recurrent trigeminal neuralgia after the primary surgery. The 50% isodose line encompassed thetarget area for radiation. The trigeminal root entry zone was included in a single target area in 33 patients,and in 5 patients, two target areas were chosen. Results All patients were followed up for 12 to 108months (mean 55 months) by telephone. The pain relief lasted for 1 to 180 days (mean 120 days) after thesecond gamma knife radiosurgery. The primary stereotactic radiosurgery resulted in a complete or partialpain relief rate of 91.7%(254/277). In the 23 patients with refractory trigeminal neuralgia, the secondradiosurgery achieved a pain relief rate of 73.9% (17/23), significantly lower than the rate of 100%(15/15) in the 15 patients with recurrent trigeminal neuralgia (P=0.045). Facial numbness or paresthesiaoccurred in 30 patients (10.8%) after the primary radiosurgery, and in another 8 patients (21.1%) after thesecond surgery. Conclusion Gamma knife stereotactic radiosurgery is safe and effective and causesfew complications for relieving trigeminal neuralgia. A repeat gamma knife stereotactic radiosurgery isalso effective for management of recurrent or refractory trigeminal neuralgia, especially in recurrentcases.