原发性三叉神经痛伽玛治疗后面部感觉异常情况分 析简

目的分析伽玛刀治疗原发性三叉神经痛病人面部感觉异常发生率及其与疼痛缓解间的关系。方法回顾性分析45例接受伽玛刀治疗并有完整随访的原发性三叉神经痛病例资料，记录和分析疼痛控制效果、起效时间以及面部感觉异常等并发症发生情况。结果中位随访时间15个月（12～37个月）。术后初始疼痛缓解BNIⅠ级15例（33-3％），Ⅱ级13例（28．9％），Ⅲ级8例（17．8％），Ⅳ级5例（11．1％），Ⅴ级4例（8．9％）；伽玛刀治疗整体有效率为80％。至最后一次随访，复发6例（13.3％），（初始疼痛缓解为BNII级3例，Ⅲ级3例）；平均复发时间11．7个月（5～18个月）。伽玛刀治疗后新发面部感觉异常17例（37．8％），疼痛完全缓解者新出现面部感觉异常的比例明显高于部分缓解或疗效不佳者（P〈0．05）。结论伽玛刀是有效的三叉神经痛治疗方法．术后面部感觉异常发生可能与更好的疼痛缓解相关。

Analysis of facial paresthesia after gamma knife radiosurgery for trigeminal neuralgia

Objective To analyze the relationship between the incidence of facial paresthesia and pain relief after gamma knife radiosurgery in trigeminal neuralgia patients. Methods Clinical data of 45 patients with trigeminal neuralgia undergoing gamma knife were analyzed retrospectively. The patients were followed up periodically. The effect of pain control, onset time and complications such as facial paresthesia were recorded and analyzed. Results The median follow-up was 15 months （12-37 months）. According to Borrow Neurology Institute （BNI）, the initial postoperative pain relief grade I was achieved in 15 cases （33.3%）, grade 11 in 13 （28.9%）, grade III in 8 （17.8%）, grade IV in 5 （11.1%） and grade V in 4 （8.9%）. The overall response rate was 80%. At the last point of the follow-up, pain recurrence was seen in 6 patients （13.3%） including BNI grade I in 3 and grade HI in 3. Mean time to pain recurrence was 11.7 months （5-18 months）. Seventeen patients （37.8%） experienced facial paresthesia after gamma knife. The proportion of emerging facial paresthesia was significantly higher in patients achieving complete remission of pain than in those with poor efficacy or partial remission （P 〈 0.05）. Conclusions The gamma knife radiosurgery is an effective treatment for trigeminal neuralgia, and facial paresthesia after surgery may be associated with better pain relief.