三叉神经痛的伽玛刀治疗

目的　探讨伽玛刀治疗三叉神经痛（ＴＮ） 的方法和疗效。方法　采用１－５ Ｔ ＭＲ 影像、ＧａｍｍａＰｌａｎ 定位和治疗计划，Ｌｅｋｓｅｌｌ 伽玛刀（γ刀） 治疗７５ 例ＴＮ，其中６５ 例非肿瘤性ＴＮ，治疗靶点在三叉神经感觉根入桥脑区，单个４ ｍｍ 准直器，中心剂量７０～９０ Ｇｙ，５０ ％ 等剂量线限定靶点；１０ 例颅底肿瘤性三叉神经痛以肿瘤为照射靶区，中心剂量２０ ～３０ Ｇｙ，周边剂量１０ ～１５ Ｇｙ。结果　随访３ ～３８ 个月，全组疗效优者占５７－３％ ，良占３０－７ ％ ，有效占５－３％ ，总有效率９３－３％ ，非肿瘤性ＴＮ总有效率９２－３ ％ 。４ 例于５ ～１７ 个月疼痛复发。全组病人无任何并发症，无死亡。结论　伽玛刀是治疗三叉神经痛安全和有效的治疗方法。

Gamma knife radiosurgery for the treatment of trigeminal neuralgia.

Objective To investigate the effectiveness of Gamma knife radiosurgery for the treatment of trigeminal neuralgia. Methods Target localization and dose plan were done by stereotactic MR(1.5 Tesla) study and Leksell Gamma Plan. Single 4 mm collimator with central dose 70 to 90 Gy and 50% isodose line conforming were directed at the sensory root of trigeminal nerve entry zone of pones for 65 patients with non tumor related trigeminal neuralgia, and for 10 patients with tumor related trigeminal neuralgia. The marginal dose used ranged from 10 to 15 Gy. Results The follow up period ranged form 3 to 38 months. Excellent result were obtained in 57 3%, good result in 30 7%, and moderate results in 5.3%, The total response rate was 93.3% and the overall response rate for non tumor related trigeminal neuralgia was 92.3%. Four patients experienced recurrent pain after 5 to 17 months. Neither complication nor motality was found during follow up. Conclusions Gamma knife radiosurgery is an effective and safe method for the treatment of trigeminal neuralgia.